Console-integrated real-time three-dimensional image overlay navigation for robot-assisted partial nephrectomy with selective arterial clamping: early single-centre experience with 17 cases

Abstract

The objective of this study was to describe our early experience with robot-assisted partial nephrectomy (RAPN) incorporating selective arterial clamping, using an image overlay navigation system. Three-dimensional images were reconstructed from computed tomography using open source processing software, OsiriX, and were directly visualized on the screen of a da Vinci surgeon's console with TilePro multi-input display functions. Using this imaging system, RAPN with selective arterial clamping was performed in 17 patients with renal tumours. The intraoperative image overlay navigation system made it possible to clearly show the tumour position and vascular supply within the console's field of view, and facilitate selective arterial clamping during RAPN, resulting in a mean decrease in estimated glomerular filtration rates at both 1 and 4 weeks after RAPN < 10 ml/min/1.73 m(2) . RAPN with selective arterial clamping using this innovative imaging system could be a useful alternative to conventional RAPN.