Robotic Vena Cava Thrombectomy with Three-dimensional Augmented Reality Guidance.

Area of Science:

• Urology
• Surgical Oncology
• Medical Technology

Background:

• Robotic surgery is increasingly utilized for renal cell carcinoma (RCC) involving neoplastic thrombus in the renal vein or inferior vena cava (IVC).
• Precise identification of thrombus extent is critical for successful surgical intervention.
• Three-dimensional augmented reality (3D AR) offers potential for enhanced visualization during complex procedures.

Observation:

• A prospective study enrolled five patients with nonmetastatic RCC and level 0-I venous thrombus undergoing robot-assisted radical nephrectomy and thrombectomy with 3D AR guidance.
• The 3D AR system was employed to visualize and delineate the thrombus location within the renal vein and IVC.
• Surgical metrics included operative time (mean 123 min), IVC clamping time (mean 9.4 min), and estimated blood loss (mean 750 ml).

Findings:

• The 3D AR system accurately identified thrombus location in all five patients.
• Surgeons utilized the 3D AR guidance to correctly estimate thrombus margins and inform surgical strategy.
• No intraoperative complications or significant postoperative complications (Clavien-Dindo grade >2) were reported.

Implications:

• 3D AR guidance can improve the precision of robotic surgery for RCC with venous thrombus.
• Enhanced visualization may lead to optimized surgical planning and execution, potentially reducing complications.
• This technology holds promise for improving outcomes in complex oncologic surgeries involving vascular structures.