Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

E R Hyde,L U Berger,N Ramachandran,S Ourselin,F H Mumtaz,A Bex,A Hughes-Hallett,N P Pavithran,M G B Tran

doi:10.1007/s11548-019-01913-5

Abstract

PurposeTo determine whether the interactive visualisation of patient-specific virtual 3D models of the renal anatomy influences the pre-operative decision-making process of urological surgeons for complex renal cancer operations.MethodsFive historic renal cancer patient pre-operative computed tomography (CT) datasets were retrospectively selected based on RENAL nephrectomy score and variety of anatomy. Interactive virtual 3D models were generated for each dataset using image segmentation software and were made available for online visualisation and manipulation. Consultant urologists were invited to participate in the survey which consisted of CT and volume-rendered images (VRI) for the control arm, and CT with segmentation overlay and the virtual 3D model for the intervention arm. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered.ResultsTwenty-five participants were recruited (54% response rate), with 19/25 having > 5 years of renal surgery experience. The median anatomical clarity score increased from 3 for the control to 5 for the intervention arm. A change in planned surgical approach was reported in 19% of cases. Virtual 3D models increased surgeon confidence in the surgical decisions in 4/5 patient datasets. There was a statistically significant improvement in surgeon opinion of the potential utility for decision-making purposes of virtual 3D models as compared to VRI at the multidisciplinary team meeting, theatre planning, and intra-operative stages.ConclusionThe use of pre-operative interactive virtual 3D models for surgery planning influences surgical decision-making. Further studies are needed to investigate if the use of these models changes renal cancer surgery outcomes.

Highlights

The evolution and uptake of laparoscopic and roboticassisted techniques have led to an increase in the use of minimally invasive partial nephrectomy (PN), known as nephron-sparing surgery, for the treatment of the small renal mass [1,2,3]
This study aimed to demonstrate a possible improvement in the tools available to the urologist for surgery planning and to investigate how the proposed technology compares to the status quo
This study investigated the impact of virtual 3D models on the key clinical decision of whether to use an open, laparoscopic, or robotic surgical approach to partial nephrectomy

Summary

Introduction

The evolution and uptake of laparoscopic and roboticassisted techniques have led to an increase in the use of minimally invasive partial nephrectomy (PN), known as nephron-sparing surgery, for the treatment of the small renal mass [1,2,3]. Surgical planning for minimally invasive PN is complex, with numerous patient and tumour characteristics having to be accounted for, especially the relationship between the tumour and renal hilar anatomy. VRI can only reveal structural information when tissue contrast is high, VRI can only be applied to a single scan at a time, and VRI supplies no semantic knowledge. Quantitative analysis such as distance/area/volume measurements cannot be undertaken and typically the relationship of the tumour to collecting or venous systems cannot be appreciated when using VRI

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