The Impact of 3D Digital Reconstruction on the Surgical Planning of Partial Nephrectomy: A Case-control Study. Still Time for a Novel Surgical Trend?

Augmented Reality to Guide Selective Clamping and Tumor Dissection During Robot-assisted Partial Nephrectomy: A Preliminary Experience

“…First, in our study, we observed a significant difference between preoperative planning based on 2D conventional imaging and the reassessment of surgical planning after revision of the 3D model, resulting in a higher rate (80% vs. 13.4%) of selective and super-selective arterial clamping (P ¼ .03). Accordingly, Bianchi et al 15 reported that the rate of intraoperative selective clamping was significantly higher in patients referred to PN with the use of 3D virtual models compared with individuals scheduled for preoperative planning based on conventional 2D imaging (57.1% vs. 13.3%; P ¼ .01). Moreover, we found no significant differences between the preoperative plan of arterial clamping based on the 3D virtual model and the effective intraoperative approach to the renal hilum guided by AR (P ¼ .4).…”

“…13 The highfidelity 3D reconstruction of renal vasculature allows the surgeon to be more confident with selective or super-selective clamping 14 and to change the preoperative plan based on 2D imaging toward a more selective clamping approach. 11,15 An additional step towards the precise medicine and imaging-guided surgery is the adoption of augmented reality (AR) in different surgical interventions. [16][17][18][19][20][21][22] During PN, the AR technology can facilitate a rapid and accurate anatomic identification of the renal vasculature.…”

“…Segmentation (ie, the labeling of each structure of interest in each CT slice) was achieved using D2P software ('DICOM to PRINT'; 3D Systems Inc, Rock Hill, SC), a modular software package designed to convert DICOM patient medical images into 3D digital models, and CE-certified for the purpose of preoperative surgical planning. 15 Manual refinement of the overall obtained automatic/semiautomatic segmentation output was carried out in 2 to 4 hours. The segmented anatomic structures arising from the multiple imaging series were then combined into 1 file using alignment of common regions, such as the healthy renal parenchyma that was segmented in all the series (Figure 1).…”

“…the 3D model on the surgical field. 15 The size and shape of the kidney during a PN also may vary both because of the surgeon's manipulation of the organ and the dissection of tissues. 29 Indeed, the 3D virtual model displayed in AR is manually moved and adjusted on the surgical field by an assistant near the surgical console with a dedicated computer and software for AR, with a potential impact on reducing the precision of the tracking and lengthening the surgical time.…”

The Wearable VOSTARS System for Augmented Reality-Guided Surgery: Preclinical Phantom Evaluation for High-Precision Maxillofacial Tasks

“…In the last two decades, new tools based on three-dimensional (3D) imaging and advanced digital technologies have become available to surgeons during pre-, intra-and postoperative phases of an intervention in the cranio-maxillofacial field [4][5][6][7][8], as well as in other surgical specialties, such as neurology, urology, vascular surgery, orthopedics [9][10][11][12][13][14][15][16][17].…”