Virtual simulation, preoperative planning and intraoperative navigation during laparoscopic partial nephrectomy

The use of computer navigation systems is a new and actively explored method used for surgical procedures concerning the abdominal and retroperitoneal organs. In this paper, we propose an original hardware - software complex, which forms a virtual body model, based on preoperative computer tomography data, transmitted to the operating screen monitor using a surgical navigation system, involving a mechanical digitizer.

During a laparoscopic procedure, a three-dimensional (3D) model of a kidney with a tumor was used to obtain additional information on the primary or secondary monitor or for combining the virtual model and video images on the main or additional monitor in the operating room. This method was used for laparoscopic partial nephrectomy, where twelve patients were operated with an average age of 45.4 (38-54) years, with clear cell renal cell carcinoma size 27.08 (15-40) mm.

All patients successfully underwent laparoscopic partial nephrectomy with intraoperative navigation. The mean operative time was 97.2 (80-155) minutes, warm ischemia time - 18.0 (12-25) minutes. Selective clamping of segmental renal arteries was performed in 7 (58.3%) cases, in the remaining 5 (41.6%) cases the renal artery was clamped. There were no serious complications. The average duration of hospital stay was 7.0 (5-10) days.

Preliminary results of our clinical study have shown the success of 3D modeling for qualitative visualization of kidney tumors in the course of surgical intervention, both for the surgeon and for the patient to understand the nature of the pathological process.