Real-time navigation by three-dimensional virtual reconstruction models in robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction: our initial experience

Sida Cheng; Xinfei Li; Weijie Zhu; Wanqiang Li; Jie Wang; Jian Yang; Jingyun Wu; He Wang; Lei Zhang; Xuesong Li; Liqun Zhou

doi:10.21037/tau-20-1006

Real-time navigation by three-dimensional virtual reconstruction models in robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction: our initial experience

Transl Androl Urol. 2021 Jan;10(1):125-133. doi: 10.21037/tau-20-1006.

Authors

Sida Cheng¹, Xinfei Li¹, Weijie Zhu¹, Wanqiang Li², Jie Wang¹, Jian Yang³, Jingyun Wu⁴, He Wang⁴, Lei Zhang¹, Xuesong Li¹, Liqun Zhou¹

Affiliations

¹ Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
² Department of Urology, The First College of Clinical Medical Science, Three Gorges University/Yichang Central People's Hospital, Yichang, China.
³ Laboratory of Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China.
⁴ Department of Medical Imaging, Peking University First Hospital, Beijing, China.

Abstract

Background: The aim of this study was to evaluate the effectiveness and safety of real-time surgical navigation by three-dimensional (3D) virtual reconstruction models in robot-assisted laparoscopic pyeloplasty (RALP).

Methods: Between November 2018 and January 2020, 38 patients with ureteropelvic junction obstruction (UPJO) who underwent RALP were retrospectively enrolled. The operations were assisted in real time by 3D models in 16 patients, while 22 patients underwent surgery without navigation. Based on whether patients had a prior intervention history, crossing vessels or congenital deformities, we further divided them into the "complicated UPJO" cohort and the "regular UPJO" cohort for subgroup analysis. The demographic characteristics, intraoperative parameters, perioperative data and follow-up data were recorded and compared between the groups.

Results: All of the procedures were successfully performed without open or laparoscopic conversion. The mean dissection time to the UPJ was shorter in the navigation group than in the non-navigation group, both in the whole cohort (15.3 vs. 24.8 min, P=0.011) and in the complicated cohort (15.4 vs. 27.5 min, P=0.004), while there was no significant difference in the regular cohort. The overall operative time and estimated blood loss in the navigation group tended to be less, although the difference was not statistically significant. No difference in anastomosis time, postoperative hospital stay or complications was noted between the two groups in either cohort. At a mean follow-up of 11.2 months, the overall success rate was 94.7% (36/38), and there was no significant difference between the two groups.

Conclusions: Real-time navigation by 3D virtual reconstruction models might be helpful to improve surgical efficiency and safety of RALP by facilitating the dissection around the UPJ, especially for cases of complicated UPJO. However, the prospective study with larger sample size is further needed to confirm the results.

Keywords: Three-dimensional reconstruction model; robot-assisted laparoscopic pyeloplasty (RALP); surgical navigation; ureteropelvic junction dissection.