Introduction: Computed tomography (CT) requires surgeons to translate more than 2000 images into a mental understanding of the renal anatomy prior to laparoscopic donor nephrectomy (LDN). In contrast, interactive virtual reality (iVR) provides a three-dimensional (3D) “hands-on” experience with the donor’s renal anatomy. Herein, we present a retrospective, case-controlled study to determine if iVR renal models viewed prior to LDN positively impacted surgery.
Methods: Twenty patients undergoing LDN were prospectively recruited. Their CT images were transformed into 3D models and uploaded to an iVR platform. The iVR platform allowed participants to rotate and deconstruct the renal anatomy utilizing a headset and hand-held devices. Surgeons answered questionnaires that assessed their understanding of renal anatomy after viewing CT alone and then after viewing CT+iVR. Patients assessed their anatomical understanding and anxiety level before and after iVR. Surgical outcomes for the iVR cohort included operative time, estimated blood loss, and postoperative complications; these data were compared to a retrospectively-matched, non-iVR cohort of LDN patients based on age, gender, BMI, ASA score, and surgeon from 2013 to 2018.
Results: Surgeons altered their surgical plans in 18 out of 20 LDNs (90%) after viewing iVR models due to a significant improvement in understanding of the vascular anatomy (p < 0.001); they also noted increased confidence in the final surgical plan (p < 0.001) (Table 1). Postoperatively, surgeons reported that iVR correlated better with patient anatomy than did CT alone (p < 0.001). Patients reported a better understanding of their anatomy (4.9/5) and decreased anxiety about their surgery (4.5/5) after viewing iVR. When compared to a non-iVR retrospective cohort, the iVR cohort had a mean 24% reduction in operative time (190 ± 57 min vs. 252 ± 67 min, p < 0.001).
Conclusions: Preoperative viewing of CT-derived iVR models altered the operative approach, decreased operative time, and improved the surgeon’s confidence and understanding of the renal anatomy. As a patient education tool, viewing the iVR model reduced patients’ preoperative anxiety. Source of