Robotic Vena Cava Thrombectomy with Three-dimensional Augmented Reality Guidance

• Published in: European Urology Open Science
• Main Authors: Daniele Amparore, Enrico Checcucci, Federico Piramide, Giovanni Busacca, Gabriele Volpi, Sabrina De Cillis, Michele Sica, Paolo Verri, Alberto Piana, Michele Di Dio, Cristian Fiori, Francesco Porpiglia
• Format: Article
• Language: English
• Published: Elsevier 2024-04-01
• Subjects: Kidney cancer; Caval thrombus; Robotic surgery; Augmented reality; Three-dimensional models
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666168324002532

Robotic surgery has recently been used for treatment of renal cell carcinoma (RCC) and neoplastic thrombus located in the renal vein or inferior vena cava (IVC). Accurate identification of the thrombus location is crucial, and three-dimensional augmented reality (3D AR) may be valuable in achieving this. We enrolled patients with nonmetastatic RCC and level 0–I venous thrombus (Mayo Clinic classification) for robot-assisted radical nephrectomy and thrombectomy with 3D AR guidance. Five patients were prospectively enrolled; three had a level 0 thrombus and two had a level I thrombus. The mean operative time was 123 ± 15 min, mean IVC clamping time was 9.4 ± 6.8 min, and mean estimated blood loss was 750 ± 150 ml. The AR system allowed precise estimation of the thrombus location in all cases. No intraoperative complications or postoperative Clavien-Dindo grade >2 complications occurred. Use of 3D AR guidance allowed correct estimation of the limits of the thrombus and guided the surgeon in selecting an appropriate surgical strategy.