Telesurgery with Cognitive 3D model guidance during robot-assisted partial nephrectomy: first experience across Europe

Telesurgery has found application in the modern era using 3D technology to improve surgical performance and organ preservation outcomes. Virtual congresses were created during the Covid-19 pandemic, giving to the participants the possibility to interact through digital platforms. This study aimed to describe the feasibility of using remotely guided telesurgery while applying 3D technology to aid the surgeon with intraoperative navigation as well as preoperative planning. The generated three-dimensional reconstruction (from the CT scan and ‘segmentation’ performed by a dedicated software) was refined by a biomedical engineer under the supervision of the urologist to obtain a detailed 3D model of the organ and surrounding structures. Intraoperatively, the 3D virtual model was displayed and consulted during the intervention by the first surgeon in a cognitive manner aimed to maximize the benefits of real-time navigation. During the Techno Urology Meeting (TUM) of 2021 we offered this technology to two surgeons using the real-time connection provided by Zoom through the Tile-Pro software while an expert surgeon from Italy aided with intraoperative navigation. The patients were aged 49 and 58 years old, respectively, while tumor maximum diameters were 60 and 30 mm for the first case, and 46 mm for the second case. No major complications occurred in either case or blood transfusion was necessary intra or postoperatively. Telementoring provided the possibility to operate with the assistance of an expert surgeon who was not present in the operating room but could virtually supervise and help during critical steps. Keywords: Telesurgey, 3D models, robotics, kidney cancer