Virtual reality, involving 3D modeling from preoperative CT scans, has been used for several years to guide robot-assisted kidney cancer surgeries. Our objective is to develop an augmented reality solution that superimposes this modeling onto the intraoperative view to provide real-time surgical guidance. This video presents the initial trials of augmented reality during robot assisted radical nephrectomies with vena cava thrombectomy.
The surgeries were performed using the Da Vinci Xi surgical robot (Intuitive Surgical). We utilized three operative arms, a 30° optical lens, and two trocars (5 mm and 12 mm) for surgical assistance. The procedure was guided by intraoperative ultrasonography (Hitachi©). 3D models of the kidneys, their vasculature, tumors, and vena cava thrombi were created from the preoperative CT scans using Synapse 3D software (Fujifilm). Initially, manual alignment of the modeling with the intraoperative view was performed to enable subsequent automated organ tracking.
Tests were conducted during two robot-assisted vena cava thrombectomy surgeries in February 2024 (Novick grade 2 thrombus). Augmented reality was implemented and visible on a computer outside the robotic console. It was then transferred to the robot’s TilePro display at key moments of the surgery and compared to visual and ultrasound landmarks. Satisfactory results were achieved, with good organ tracking and coherent thrombus alignment during both surgeries.
Augmented reality surgical guidance is a technique still under development, particularly concerning the deformation of 3D models. However, these initial trials in the operating room were promising. In situations involving vena cava thrombectomy, augmented reality could facilitate the identification of thrombus limits and venous anatomy, especially improving visualization of lumbar veins to be controlled before cavotomy. This work was supported by the French government under the 3rd Investment in the Future Program, as part of France 2030, managed by the National Research Agency (ANR) and referenced as ANR-21-RHUS-0015.