Shirk Joseph D, Kwan Lorna, Saigal Christopher
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Urology. 2019 Mar;125:92-97. doi: 10.1016/j.urology.2018.12.026. Epub 2018 Dec 28.
To determine whether 3-dimensional virtual reality models of patient-specific anatomy improve outcomes in patients undergoing robotic partial nephrectomy.
Computed tomography and magnetic resonance imaging scans for 30 patients undergoing robotic partial nephrectomy were converted to 3-dimensional virtual reality models prior to the patient's operation. These models were then viewed on the surgeon's mobile phone pre- and intraoperatively using a Google Cardboard headset to assist in surgical planning. This group was compared to 30 patients who previously underwent robotic partial nephrectomy. We compared operative time, clamp time, estimated blood loss, hospital stay, complications, and margin status between these groups. We used forward selecting multivariate regression models to create the final model controlling for significant demographic and clinical variables.
When controlling for case complexity and surgeon, patients with 3-dimensional, virtual reality-assisted surgical planning had significantly lower operative time (141 minutes vs 201 minutes, P < .0001), clamp time (13.2 minutes vs 17.4 minutes, P = .0274), and estimated blood loss (134 cc vs 259 cc, P = .0233). Patients without 3-dimensional, virtual reality-assisted surgical planning were more likely to have a hospital stay of greater than 2 days (odds ratio 5.1, 95% confidence interval 1.0, 26.4). There were no complications or positive margins noted in the VR group.
Use of a 3-dimensional, virtual reality model when performing robotic partial nephrectomy improves key surgical outcome parameters.
确定患者特异性解剖结构的三维虚拟现实模型是否能改善接受机器人辅助部分肾切除术患者的手术效果。
对30例接受机器人辅助部分肾切除术的患者，在手术前将其计算机断层扫描和磁共振成像扫描转换为三维虚拟现实模型。然后，在手术前和手术中，外科医生使用谷歌纸板头显在手机上查看这些模型，以辅助手术规划。将该组患者与30例先前接受机器人辅助部分肾切除术的患者进行比较。我们比较了两组患者的手术时间、肾蒂阻断时间、估计失血量、住院时间、并发症及切缘情况。我们使用向前选择多元回归模型来创建最终模型，以控制显著的人口统计学和临床变量。
在控制病例复杂性和外科医生因素后，采用三维虚拟现实辅助手术规划的患者手术时间显著缩短（141分钟对201分钟，P <.0001），肾蒂阻断时间缩短（13.2分钟对17.4分钟，P = 0.0274），估计失血量减少（134毫升对259毫升，P = 0.0233）。未采用三维虚拟现实辅助手术规划的患者住院时间超过2天的可能性更大（比值比5.1，95%置信区间1.0，26.4）。虚拟现实组未出现并发症或切缘阳性情况。
在进行机器人辅助部分肾切除术时使用三维虚拟现实模型可改善关键手术效果参数。
