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JU INSIGHT Does IRIS, a Segmented 3D Model, Increase Surgical Precision During Robotic Partial Nephrectomy?
By: Teona Iarajuli, MD, Hackensack Meridian School of Medicine, Nutley, New Jersey; Hackensack University Medical Center, New Jersey; Christina Caviasco, MD, Hackensack Meridian School of Medicine, Nutley, New Jersey; Tanner Corse, MD, Hackensack Meridian School of Medicine, Nutley, New Jersey, Hackensack University Medical Center, New Jersey; Katherine Kim, MBS, Hackensack Meridian School of Medicine, Nutley, New Jersey; Jennifer Nguyen, BS, Hackensack University Medical Center, New Jersey; Ruth Sanchez De La Rosa, MHA, Hackensack University Medical Center, New Jersey; Simon Gelman, PhD, MS, Hackensack University Medical Center, New Jersey; Nick Spagnuolo, BSHCM, RT(R)(CT)(ARRT), Hackensack University Medical Center, New Jersey; Hannah Sidoti, MD, Hackensack Meridian School of Medicine, Nutley, New Jersey; Mitchell Miller, MD, Hackensack Meridian School of Medicine, Nutley, New Jersey, Hackensack University Medical Center, New Jersey; Michael Stifelman, MD, Hackensack Meridian School of Medicine, Nutley, New Jersey, Hackensack University Medical Center, New Jersey | Posted on: 20 Jul 2023
Iarajuli T, Caviasco C, Corse T, et al. Does utilizing IRIS, a segmented three-dimensional model, increase surgical precision during robotic partial nephrectomy?. J Urol. 2023;210(1):171-178.
Study Need and Importance
IRIS is an interactive, 3D, anatomical model displayed via TilePro within the console (see Figure). The model allows for arteries, veins, renal parenchyma, masses, and the collecting system/ureters to be color coded, facilitating interpretation of the anatomy. It also has the ability to adjust rotation and zoom to achieve intraoperative cognitive fusion. Based on the aforementioned advantages, IRIS has the potential to become a valuable tool in the surgical management of renal masses to improve surgical precision and preserve renal volume during partial nephrectomy (PN).
What We Found
We completed propensity score matched analysis between 18 IRIS and non-IRIS patients to determine whether utilizing IRIS intraoperatively improves surgical precision in PN cases. This study demonstrates that when a single experienced surgeon utilizes the 3D IRIS model during robotic PN for complex tumors, the precision is significantly improved. Regarding the efficacy of IRIS intraoperatively, we found no significant differences in operative outcomes or margin status between the cohorts. This suggests that IRIS is safe and reproducible, and improves surgical precision, without prolonging operative time or positive margin rate.
Limitations
There are some limitations to our study. There is a potential intra-observer variability for volume analysis, which we minimized by assigning the same operator to analyze both preoperative and postoperative scans for each patient. Additionally, in the cases of endophytic tumors, we may have overpredicted postoperative kidney volumes because adjacent parenchyma is removed. This can lead to an overestimation of the predicted postoperative volume, which may erroneously skew the results for both the IRIS and non-IRIS cohorts.
Interpretation for Patient Care
Our study demonstrated that the IRIS 3D model, when used intraoperatively, has the potential to improve patient outcomes post-robotic PN by improving surgical precision. Our results are clinically significant, as previous studies have already emphasized preserved renal parenchyma to be a determinant of postoperative renal function.
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