Figure 1: Axial view of standard CT scan image.
However, obtaining an accurate and thorough 3D anatomical understanding from these 2D images has been shown to be difficult: Dr. Clayman indicated that a recent study by Wake et al. has shown surgeons often have a poor 3D spatial understanding of a renal tumor’s location on the kidney after reviewing CT and MRI images alone.
Immersive Virtual Reality (iVR), on the other hand, synthesizes the axial, sagittal, and coronal information provided by CT and MRI images, and displays them as an intuitive, truly 3D, iVR anatomical model (Figure 2).
Figure 2: Immersive and interactive iVR model of a kidney tumor. The white hand shown removing kidney parenchyma from the collecting system to reveal tumor-feeding vasculature.
Dr. Clayman discussed several clinical studies he and his team are conducting to compare the anatomical understanding provided by the iVR experience to that of CT/MRI review alone. For all three studies (partial nephrectomy, percutaneous nephrolithotomy, and living donor nephrectomy), iVR was shown to significantly increase surgeons’ anatomical understanding and confidence, while greatly reducing the patients’ preoperative anxiety. Of note, the iVR technology altered the surgeons’ surgical approach in 40% of percutaneous nephrolithotomy cases, and in 55% of partial nephrectomy cases. The effect iVR has on surgical outcomes is still being explored, however for percutaneous nephrolithotomy, it appears that iVR resulted in significantly lower fluoroscopy and bleeding times.
Certainly, this technology is the future of preoperative planning and surgical imaging. Dr. Clayman envisioned an “iVR” feature built-in to each patient’s imaging file, allowing surgeons to immediately access this technology to best prepare for their operation.
Presented by: Ralph Clayman, MD, Professor, University of California, Irvine, Department of Urology
Written by: Mitchell O’Leary, Department of Urology, University of California-Irvine, medical writer for UroToday.com. at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France