3D augmented-reality guidance during Robotic vena cava thrombectomy

This video was entered by Dr. F. Porpiglia in the 2022 KS International Robotic Surgery Innovation Awards, sponsored by the Vattikuti Foundation. It was featured in the Vattikuti Symposium ‘Humans at the Cutting Edge of Robotic Surgery,’ held in Miami, Florida November 19, 2022.

Here is the Abstract:

3D augmented-reality guidance during Robotic vena cava thrombectomy
D. Amparore, F. Piramide, A. Piana, E. Checcucci, C. Fiori, F. Porpiglia

Introduction: Nowadays a 6% of renal cell carcinoma (RCC) patients still are diagnosed with a neoplastic thrombus at the level of renal vein or inferior vena cava (IVC). Recently some laparoscopic or robotic surgeons decided to embark in this challenging procedure. To optimize the intraoperative outcomes, a correct estimation of neoplastic thrombus location is essential. During these last years 3D Augmented reality (3D-AR) guidance has been reported to be a useful tool to correctly identify renal tumor location and assist surgeon during the interventions.
Our aim was to test safety and feasibility of 3D-AR guidance during robot-assisted radical nephrectomy (RARN) with tumor thrombi in renal vein and IVC.

Methods: From November 2020 all patients scheduled for RARN due to non-metastatic RCC with venous thrombus were enrolled. During surgery, AR system was performed overlapping the 3D virtual model over the real anatomy thanks the tile pro technology of Da Vinci Console.

Results: 5 patients were enrolled. Level 0 thrombus was recorded in 3 patients, two patients had level 1 thrombus. Mean lesions size was 75.6 (+21.3) mm. Mean operative time was 123 min (+ 15min) with mean IVC clamping time of 9.4 min (+ 6.8). During the intervention the AR system allowed to precisely estimate the location of thrombus in all the cases, driving to a more awareness of the surgical strategy. Moreover, no intra- or postoperative complications (greater than 2 according to Clavien- Dindo) were recorded.

Conclusion: 3D-AR guidance seems to be safe and feasible in correctly estimate the thrombus limits

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