Category: Education, Simulation & Virtual Reality

MP19-13 - Virtual Reality Immersion for Preoperative Planning and Education for Partial Nephrectomy

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Surgeons rely on two-dimensional imaging using computed tomography (CT) or magnetic-resonance (MRI) to create a mental, three-dimensional (3D) understanding prior to surgery. Virtual reality (VR) technology immerses the user in an interactive 3D environment enabling manipulation of the pertinent anatomy. Herein, we evaluated VR models for preoperative planning and patient education prior to partial nephrectomy.


Methods : After IRB approval, using standard preoperative imaging (CT=13 and MRI=3) and 3D Slicer software, 16 VR models were created for viewing with a head-mounted display (Oculus Rift, Facebook Inc.) (Figure 1). Three expert surgeons (JL, KK, EU) evaluated their preoperative anatomical understanding (0 = poor; 10 = excellent) using CT alone vs. CT with VR. Additionally, surgeons and patients recorded their experience with the VR technology using a Likert-type scale (1=strongly disagree to 5=strongly agree).


Results : Pre-operatively, the VR model provided a significantly improved understanding of the location, size and shape of the renal mass, the optimal surgical approach, and the pertinent anatomy (i.e. vasculature, collecting system, hilar anatomy and ureteral location) compared to CT alone (p < 0.05) (Table 1). Surgeons strongly agreed (4.9/5, range 4-5) that the VR model improved understanding of the anatomy; they rated the VR model highly as a surgical planning tool (4.9/5, range 4-5) and an aid for teaching residents (4.9/5, range 4-5). In 56% of the cases, the surgical approach was altered based on the preoperative VR experience. The post-operative assessment correlated well with the surgical anatomy. The VR rendering improved patient understanding and comfort level regarding their surgery.


Conclusions : VR created 3D displays of renal anatomy prior to partial nephrectomy enhanced surgeons’ preoperative anatomical understanding and modified the surgical approach in over half of the cases. Additionally, the VR experience improved patient understanding of their impending surgery and reduced their preoperative anxiety.

Egor Parkhomenko

Resident
Boston Medical Center
Boston, Massachusetts

Shoaib Safiullah

Columbia, Missouri

Mitchell L. O'Leary

Clinical Researcher
University of California, Irvine, Department of Urology
Orange, California

Michael Owyong

Orange, California

Sartaaj Walia

Orange, California

Ryan James

Seattle, Washington

Cyrus Lin

Orange, California

Roshan M. Patel

Assistant Clinical Professor
University of California, Irvine, Department of Urology
Orange, California

Kamaljot S. Kaler

Clinical Assistant Professor
University of California, Irvine; University of Calgary
Orange, California

Edward Uchio

Orange, California

Ralph V. Clayman

Professor
University of California, Irvine, Department of Urology
Orange, California

Jaime Landman

Professor and Chair
Department of Urology, University of California, Irvine, Orange, CA
Orange, California

Professor Landman completed his medical training at Columbia University. He then completed his Urology residency at Mt. Sinai Hospital in New York before moving to St. Louis to complete his minimally invasive urology training at Washington University under the guidance of Dr. Ralph Clayman. Dr. Landman’s fellowship training focused on the minimally invasive treatment of renal diseases.

Prof. Landman focuses on developing new clinical approaches to minimally invasive and more effective treatments for surgical renal diseases such as renal cell carcinoma, urolithiasis and ureteropelvic junction obstruction. For the past decade, his clinical practice has been focused almost exclusively on the minimally invasive management of kidney disease with a focus on renal oncology and urolithiasis.

Since 2002 Dr. Landman has directed an active minimally invasive urology laboratory. His laboratory has focused largely on innovative minimally invasive solutions in the diagnosis and treatment of urologic malignancies, kidney stones and the development of minimally invasive surgical technologies.

A major focus of Dr. Landman’s efforts has been the didactic and technical training of students, residents and fellows. Dr. Landman has had an active role in medical student and resident education since 2001. Since 2002 Dr. Landman has been actively directing the Endourology sanctioned clinical and research fellowship, and he was until recently the program director for the UC Irvine Urology residency. Dr. Landman engendered and currently directs the LIFT (Leadership Innovation Fellowship Training) program at UC Irvine and has focused on helping medical students become academic leaders in Urology.

A current focus of Dr. Landman’s research remains didactic and technical training for students, residents and fellows. His research team continues to develop novel strategies for surgical education.