V04-03: A Guide to Utilizing IRIS, a Segmented 3D Model, to Improve Surgical Planning and Patient Outcomes During Robotic Partial Nephrectomy

Authors: Robert Harrison, Mutahar Ahmed, Ravi Munver, Michael StifelmanIntroduction: IRIS is an interactive, three-dimensional (3D) anatomical model system designed to assist surgeons with pre-surgical planning and provide a reference intraoperatively. Generated from preoperative CT scans with contrast, the IRIS model can be accessed via an app on the iPhone or iPad. Using TilePro, the surgeon is able to connect their device to the console and see the IRIS model on the screen. In this video, we show how IRIS can be used to improve surgical planning and patient outcomes during robotic partial nephrectomy.

Methods: In the three cases of partial nephrectomy presented in the video, each highlights some of the potential applications of the IRIS model. In case 1, a 63-year-old female with a solitary kidney and a 4-cm left renal mass, IRIS is able to help identify the arterial anatomy and the feasibility of selective clamping. In case 2, a 53-year-old female with a right hilar mass, it was unclear on pre-op imaging whether the mass should be approached anteriorly or posteriorly. In this case, IRIS helped identify the best approach (retro- or transperitoneal), identify arterial and collecting system anatomy, and in operative planning for enucleation. In case 3, a 59-year-old male with 3-cm anterior right renal mass, IRIS helped with cognitive alignment and demonstrated the potential to eliminate the need for intraoperative ultrasound.

Results: Table 1 presents institutional data from 23 partial nephrectomy cases that utilized the IRIS model. Perioperative outcomes in this small cohort, including key metrics such as median operative and ischemia time, estimated blood loss and length of stay, are all excellent.

Conclusions: As these cases demonstrate, the IRIS model provides distinct advantages compared to traditional 2D cross sectional imaging. Preoperatively, it can be utilized both for surgical planning and also as an educational aid for patients, to better explain their procedure. Intraoperatively, the ability to evaluate and manipulate the IRIS model in real time has clear application during surgery and may lead to improved patient outcomes. Although this technology has great potential, further studies are needed to evaluate its true benefits and fusion imaging is lacking.

Source of Funding: None.

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