V05-01 3D AUGMENTED REALITY-GUIDED ROBOTIC-ASSISTED KIDNEY TRANSPLANTATION: REVEALING THE CONCEALED

Abstract

You have accessJournal of UrologyCME1 May 2022V05-01 3D AUGMENTED REALITY-GUIDED ROBOTIC-ASSISTED KIDNEY TRANSPLANTATION: REVEALING THE CONCEALED Alberto Piana, Gallioli Andrea, Pietro Diana, Angelo Territo, Josep Maria Gaya, Pavel Gavrilov, Óscar Rodriguez Faba, Jordi Huguet, Lluis Guirado, Carme Facundo, Riccardo Campi, Andrea Bellin, Daniele Amparore, Sergio Serni, Joan Palou, and Alberto Breda Alberto PianaAlberto Piana More articles by this author , Gallioli AndreaGallioli Andrea More articles by this author , Pietro DianaPietro Diana More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Josep Maria GayaJosep Maria Gaya More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Óscar Rodriguez FabaÓscar Rodriguez Faba More articles by this author , Jordi HuguetJordi Huguet More articles by this author , Lluis GuiradoLluis Guirado More articles by this author , Carme FacundoCarme Facundo More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , Andrea BellinAndrea Bellin More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Sergio SerniSergio Serni More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted kidney transplantation (RAKT) has long shown solid results as a minimally invasive alternative to the standard open approach (OKT) for living donor and promising results for deceased donor. However, RAKT is still limited in those cases where the recipient’s iliac vessels present atherosclerotic plaques, frequently found in elder patients and in those subjected to long-term hemodialysis. Unlike OKT, where the surgeon can palpate the arterial plaques, in minimally-invasive surgery the haptic feedback is missing making the vascular clamping and arteriotomy unsafe. To overcome this limitation, 3-Dimensional (3D) imaging virtual reconstruction was employed using the Augmented Reality (AR) to intraoperatively locate the plaques, driving the surgeon during the crucial steps of KT. METHODS: Our study was conducted according to IDEAL model for surgical innovation. 3D printed and virtual models were obtained from high-accuracy conventional CT scan imaging and superimposed on the vessels during RAKT using the Da Vinci console software. RESULTS: In the IDEAL phase 0, 3D virtual models were obtained from patients with artery plaques, printed and compared to the vascular anatomy of the patient during 2 OKTs by manual palpation. In phase 1, the 3D virtual models of patients without plaques were superimposed during a combined open-robotic KT and 2 RAKTs. Anatomical fidelity was assessed by measuring and comparing the virtual model to the real vessels. Then, we employed the 3D AR on a clinical case without plaques during the vascular clamping and arteriotomy phases to gain insight of anatomy modification during vessel dissection. The correspondence of 3D virtual models with the real anatomy of patients with plaques was tested by scanning the iliac arteries with a robotic ultrasound (US) probe in 10 patients undergoing robotic-assisted iliac lymph-node dissection for prostate cancer. Finally, after US confirmation, the 3D-AR accurately enabled the surgeon to place the clamp and perform the arteriotomy safely in a clinical case with arterial plaques. CONCLUSIONS: The employment of 3D-AR allowed to overcome one of the main limitations of RAKT, setting the foundation to expand its indications to patients with advanced atheromatic vascular disease. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e516 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Piana More articles by this author Gallioli Andrea More articles by this author Pietro Diana More articles by this author Angelo Territo More articles by this author Josep Maria Gaya More articles by this author Pavel Gavrilov More articles by this author Óscar Rodriguez Faba More articles by this author Jordi Huguet More articles by this author Lluis Guirado More articles by this author Carme Facundo More articles by this author Riccardo Campi More articles by this author Andrea Bellin More articles by this author Daniele Amparore More articles by this author Sergio Serni More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF DownloadLoading ...