Presented by: Michael Frumer MD
Rabin Medical Center

Introduction

One of the main challenges in partial nephrectomy is spatial orientation and understanding the relationship between the mass and critical anatomical structures to achieve negative surgical margins and preserve the remaining structures. Today, the surgeon determines the planes of surgery through cognitive planning based on a preliminary review of pre-operative imaging, whereas in real-time, the anatomy is dynamic as the operation progresses. An augmented reality system includes virtual illustrations that merge with the environment in real-time and are highlighted in the resulting image. This interactive system has the potential to help the surgeon navigate the surgical field by illustrating the location and boundaries of hidden structures.

Materials

The clinical characteristics and pre-operative CT files of patients who underwent robotic-assisted partial nephrectomy were collected, as well as the surgery film, which includes the information obtained from the robot's camera and an intraoperative drop-in sonar probe. Using pre-operative imaging, surgical film, advanced deep learning tools, and 3D reconstruction, we will create a computerized system to visually present hidden anatomical structures and tumor boundaries.

Results

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Thus far, data from 5 patients have been processed. Their characteristics are detailed in Table 1.

Illustrative images from the augmented reality system are currently in the advanced stages of development and will be presented. 

Conclusion

In the future, it will be possible to use a computerized system for a real-time virtual presentation of the hidden anatomical structures and tumor boundaries. The system may shorten surgery time, reduce complications, and help the beginner surgeon.

Funding

RSIP vision ltd

Co-Authors

Daniel Kedar, MD
Rabin Medical Center

Jack Baniel, MD
Rabin Medical Center

Andrew Nado, MD
Rabin Medical Center

Shay Golan,
Rabin Medical Center