V04-04 CLINICAL APPLICATION OF 3D ANATOMICAL MODELING SOFTWARE (IRIS TM ) DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY (RAPN) FOR COMPLEX RENAL MASSES

Abstract

You have accessJournal of UrologyAdrenal & Renal Oncology I (Nephron Sparing Surgery) (V04)1 Sep 2021V04-04 CLINICAL APPLICATION OF 3D ANATOMICAL MODELING SOFTWARE (IRISTM) DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY (RAPN) FOR COMPLEX RENAL MASSES Ahmed Ghazi, Tyler Holler, Thomas Frye, William Tabayoyong, Jonathan Bloom, Hani Rashid, and Jean Joseph Ahmed GhaziAhmed Ghazi More articles by this author , Tyler HollerTyler Holler More articles by this author , Thomas FryeThomas Frye More articles by this author , William TabayoyongWilliam Tabayoyong More articles by this author , Jonathan BloomJonathan Bloom More articles by this author , Hani RashidHani Rashid More articles by this author , and Jean JosephJean Joseph More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002000.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: IRISTM is an interactive three dimensional (3D) anatomic modeling software allowing functional manipulation of anatomical models for the surgical planning of renal masses. The software represents converted DICOM files of CT images to 3D virtual anatomical models, viewed on an iOS device during preoperative surgical planning and the da Vinci surgical system TilePro input for intraoperative navigation. The objective of this video is to demonstrate the clinical utility and application of IRISTM as a preoperative planning and intraoperative navigation tool during RAPN in two patients with highly complex renal masses. METHODS: The first case is a 73 year old male patient with a 2.7 cm right, completely endophytic hilar renal mass. Nephrometry score was 10h. The second case was a 45 years old male presenting with a 7.8 by 7.6 cm, exophytic, left hilar posterior renal mass with a nephrometry score of 11p. Preoperative planning was completed utilizing axial imaging and IRIS on an iOS device and a surgical plan put forth. Intraoperative navigation was via the da Vinci surgical system TilePro input. Perioperative and intraoperative patient data was collected. RESULTS: In the first case, IRIS helped visualize the resection cavity exposing the surrounding vascular branches that could be injured during tumor resection, identifying the feeding vessels perfusing the tumor and predicting structures encountered during suturing at the base of the resection bed during renoprraphy. Estimated Blood loss (EBL) was 100cc, Warm ischemia time (WIT) 17 minutes, with minimal change in postoperative renal function. Final pathology was positive for an Oncocytoma with negative margins. In the second case with an exophytic tumor, the transparency function allowed for identification of vital structures that would be encountered at the resection base. In this case a large portion of the pelvicaliceal system (PCS) abutting the tumor base and a feeding branch to the tumor from the renal artery were accurately localized by altering parenchyma and tumor transparency in the IRIS model. EBL was 60cc, WIT 28 minutes and renal function was maintained postoperatively. Pathology was positive for clear cell carcinoma with negative margins. CONCLUSIONS: IRISTM technology with its interactive features, offered valuable preoperative and intraoperative information not attainable by standard axial imaging in the robotic approach for surgical management of complex renal masses. Source of Funding: Inuititive Inc. Clinical trial © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e292-e292 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ghazi More articles by this author Tyler Holler More articles by this author Thomas Frye More articles by this author William Tabayoyong More articles by this author Jonathan Bloom More articles by this author Hani Rashid More articles by this author Jean Joseph More articles by this author Expand All Advertisement Loading ...