Search

Purpose: The aim of this systematic review is to assess the clinical implications of employing various Extended Reality (XR) tools for image guidance in urological surgery. Methods: In June 2023, a systematic electronic literature search was conducted using the Medline database (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy was designed based on the PICO (Patients, Intervention, Comparison, Outcome) criteria. Study protocol was registered on PROSPERO (registry number CRD42023449025). We incorporated retrospective and prospective comparative studies, along with single-arm studies, which provided information on the use of XR, Mixed Reality (MR), Augmented Reality (AR), and Virtual Reality (VR) in urological surgical procedures. Studies that were not written in English, non-original investigations, and those involving experimental research on animals or cadavers were excluded from our analysis. The quality assessment of comparative and cohort studies was conducted utilizing the Newcastle-Ottawa scale, whilst for randomized controlled trials (RCTs), the Jadad scale was adopted. The level of evidence for each study was determined based on the guidelines provided by the Oxford Centre for Evidence-Based Medicine. Results: The initial electronic search yielded 1,803 papers after removing duplicates. Among these, 58 publications underwent a comprehensive review, leading to the inclusion of 40 studies that met the specified criteria for analysis. 11, 20 and 9 studies tested XR on prostate cancer, kidney cancer and miscellaneous, including bladder cancer and lithiasis surgeries, respectively. Focusing on the different technologies 20, 15 and 5 explored the potential of VR, AR and MR. The majority of the included studies (i.e., 22) were prospective non-randomized, whilst 7 and 11 were RCT and retrospective studies respectively. The included studies that revealed how these new tools can be useful both in preoperative and intraoperative setting for a tailored surgical approach. Conclusions: AR, VR and MR techniques have emerged as highly effective new tools for image-guided surgery, especially for urologic oncology. Nevertheless, the complete clinical advantages of these innovations are still in the process of evaluation. [ABSTRACT FROM AUTHOR]

More than ever, precision surgery is making its way into modern surgery for functional organ preservation. This is possible mainly due to the increasing number of technologies available, including 3D models, virtual reality, augmented reality, and artificial intelligence. Intraoperative surgical navigation represents an interesting application of these technologies, allowing to understand in detail the surgical anatomy, planning a patient-tailored approach. Automatic superimposition comes into this context to optimally perform surgery as accurately as possible. Through a dedicated software (the first version) called iKidney, it is possible to superimpose the images using 3D models and live endoscopic images during partial nephrectomy, targeting the renal mass only. The patient is 31 years old with a 28 mm totally endophytic right-sided renal mass, with a PADUA score of 9. Thanks to the automatic superimposition and selective clamping, an enucleoresection of the renal mass alone was performed with no major postoperative complication (i.e., Clavien–Dindo < 2). iKidney-guided partial nephrectomy is safe, feasible, and yields excellent results in terms of organ preservation and functional outcomes. Further validation studies are needed to improve the prototype software, particularly to improve the rotational axes and avoid human help. Furthermore, it is important to reduce the costs associated with these technologies to increase its use in smaller hospitals. [ABSTRACT FROM AUTHOR]

The purpose is to verify whether patients with Long Covid-19 symptoms can recover Functional Capabilities and Endurance reaching the normotype subjects' level. The study is a before-after trial comparing the affected sample with baseline normotype data. The study was carried out at the private clinic "Move Different" near Aosta Italy. The clinic has an agreement with public health for a project for patients with Long Covid-19 symptoms. About 60 subjects (mean age 62+-3) healed from Covid-19 Virus with more than one day of hospitalization, older than 60 years old were included. They were divided into two clusters: Low Performance Patients (LPP) and Medium Performance Patients (MPP), decided by the Medical Equipe. The program consisted of 10 sessions of 1h, divided into 2/3 treatments per week; based on the use of Virtual Reality and Augmented Reality through a Digital Mirror. Tests were performed before and after the intervention. Increase in meters covered in the 6 Minutes Walking Test (MPP increases 56+- 65 meters, LPP increases 99+-74 meters). Wilcoxon test was performed between pre and post 6MWT for both of populations (pvalue < 0.005, pvalue < 0.005). After the treatment, results are close to normative data of Perera et al, 2006, Geriatrics. The improvement of both groups is statistically significantly difference; data support that especially the medium-functional group achieves the similar level of normotype subjects. A future randomized control trial aimed at testing whether improvement of this method over a traditional one is suggested. The authors declared no potential conflicts of interest with respect to the research authorship and/or publication of this poster. [ABSTRACT FROM AUTHOR]

The recent integration of new virtual visualization modalities with artificial intelligence and high-speed internet connection has opened the door to the advent of the metaverse in medicine. In this totally virtual environment, three-dimensional virtual models (3DVMs) of the patient's anatomy can be visualized and discussed via digital avatars. Here we present for the first time a metaverse preoperative clinical case discussion before minimally invasive partial nephrectomy. The surgeons' digital avatars met in a virtual room and participated in a virtual consultation on the surgical strategy and clamping approach before the procedure. Robotic or laparoscopic procedures are then carried out according to the simulated surgical strategy. We demonstrate how this immersive virtual reality experience overcomes the barriers of distance and how the quality of surgical planning is enriched by a great sense of "being there", even if virtually. Further investigation will improve the quality of interaction with the models and among the avatars. [ABSTRACT FROM AUTHOR]