MP24-18: The Effect of Virtual 3D Models on Robotic Partial Nephrectomy: Secondary Analysis of a Randomized Clinical Trial

Joseph Shirk*, Los Angeles, CA, David Thiel, Jacksonville, FL, Eric Wallen, Chapel Hill, NC, Jennifer Linehan, Santa Monica, CA, Wesley White, Knoxville, TN, Ketan Badani, Ney York, NY, James Porter, Seattle, WA

Introduction: Planning complex operations such as robotic-assisted partial nephrectomy requires surgeons to review two-dimensional Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) images to understand three-dimensional, patient-specific anatomy.  We compared surgeon-reported effects of virtual 3-dimensional (3D) models on operative planning to surgical outcomes for patients undergoing robotic-assisted partial nephrectomy.

Methods: Ninety-two patients undergoing robotic-assisted partial nephrectomy performed by eleven surgeons at six large teaching hospitals were prospectively enrolled and randomized in a randomized, single-blind, clinical trial.  Patients were assigned either to a control group undergoing usual preoperative planning with CT and/or MRI imaging only, or to an intervention group where imaging was supplemented with a three-dimensional, virtual reality model.  This model was viewed on the surgeon’s mobile phone in regular three-dimensional format, and in virtual reality using an off-the-shelf virtual reality headset. The primary outcome measure was operative time.  Secondary outcomes were clamp time, estimated blood loss, and hospital length of stay. For the 47 patients in the intervention group, surgeons filled out a survey in which they rated various aspects of the model and operation, either using yes/no questions or a 5-point Likert scale. The clinical survey responses were then compared to the outcome measures to determine if they affected the operation.

Results: Forty-seven patients were analyzed, and were generally older (65.6±10.5 yrs), white (81%), and male (60%).  After controlling for significant covariates, using a multivariable linear model, cases in which the surgeon reported modifying their preoperative plan (28%) after viewing the model had significantly lower operative time, estimated blood loss, and clamp time (p < 0.05).  Increasing confidence after viewing the model was associated with significantly lower operative time, estimated blood loss, and clamp time as well (p < 0.05) (Table 1).

Conclusions: Use of a virtual 3D VR model when performing robotic partial nephrectomy improves key surgical outcome parameters.

Source of Funding: None