Introduction: In last decades image guided surgery gained wide interest, for its potential in correlating the preoperative imaging with the intraoperative evidence. In this context, new hyper-accuracy 3D virtual models (3DVMs), providing a better comprehension of surgical anatomy both in planning and surgical navigation, found wide spreading in robotic surgery. However, also for laparoscopy their use is under evaluation. Up to now, the main limit of their application in this setting is the difficulty to bring them into the operative field.
Aim of the study is to present the ICON3D platform, a new technological tool for 3DVMs guidance during laparoscopic surgery, assessing its usefulness in the setting of laparoscopic partial nephrectomy (LPN).
Methods: The ICON3D platform finds application both for preoperative planning and intraoperative navigation. In these settings, the main issue is represented by the impossibility by the surgeon to interact with non-sterile input devices, needing the aid of an un-scrubbed assistant. 3DVM independent manipulation is obtained with touchless gesture control composed by an image management software with infrared-based sensor. Once connected, the surgeon can manipulate the 3DVM on the screen of the ICON3D rack, put close to the screen of a standard laparoscopic rack. For the purpose of the study, a 3DVM of the kidney harboring the renal mass has been produced from standard computed tomography images for all the consecutive patients scheduled for LPN from 12/2020 to 10/2021. Once downloaded into the ICON3D platform, each model has been navigated by the surgeon as assistance during the intervention. Demographic and perioperative data, including the time of 3DVM touchless gesture interaction during the procedure have been recorded, as well as pathological and functional data.
Results: ICON3D technology was tested in 12 LPNs. The median lesion size was 38 (27;52) mm, while the median PADUA score was 7 (7;9). Retroperitoneal approach was chosen for 83.3% of the patients. Median time of intraoperative ICON3D touchless gesture interaction was 7 (5;9) minutes. 10/12 patients underwent selective clamping under 3DVM guidance and in 2/10 only the collecting system was violated. No intraoperative complications were recorded. 1/12 patient experienced a major postoperative complication, with a bleeding requiring embolization.
No positive surgical margins were recorded, and renal function remained stable after surgery (eGFR drop -7.4%).
Conclusions: ICON3D platform seems to be a useful technological tool in assisting LPN. Its enhanced usability in a sterile operative field with touchless gesture control, allowing intraoperative planning and navigation via 3DVMs, can optimize the surgical outcomes of the intervention, both considering the clamping strategy and the renal defect repair.