Editorial Comment: Effect of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Partial Nephrectomy on Surgical Outcomes: Qualitative Data from a Randomized Clinical Trial

摘要

Virtual reality (VR) is used in surgical planning by converting patient-specific imaging data into immersive 3-dimensional (3D) models. Surgeons can manipulate these virtual reconstructions, gaining a comprehensive understanding of the patient's anatomy and identifying optimal pathways for procedures, particularly for partial nephrectomies.1 The creation of VR-3D models for surgical planning poses challenges, requiring high-quality imaging data, specialized software, and experience in medical imaging and 3D modeling.1 The study by Shirk et al2 revisits the authors' prior randomized controlled trial, qualitatively evaluating what allows for improvement in operative factors with use of the 3D models in conjunction with radiologic imaging for preoperative and intraoperative evaluation in robot-assisted partial nephrectomy (RAPN). Surgeon surveys yielded qualitative data indicating that 3D models significantly improved visualization, positively influenced operative planning, and correlated with enhanced outcomes. Particularly noteworthy were cases where surgeons modified their preoperative plans or reported increased confidence after reviewing the 3D models. Despite the randomized and multi-institutional nature of the study, its single-blind design, where surgeons were aware of the intervention while patients were blinded to group assignment, raises concerns about potential bias in surgeon behavior and reporting. In addition, reliance on qualitative data from surveys introduces subjectivity and response bias, with the Likert scale possibly limiting the spectrum of surgeon opinions. The study was underpowered to report differences in surgical outcomes of surgeons with less versus those with more experience in RAPN using VR-3D models. Generalizability is questionable because the study's results may not fully extend to surgical settings outside tertiary hospital systems because of potential limitations in costs or access to necessary software systems.3 Despite these limitations, the study effectively demonstrates that VR-3D models contribute to enhanced surgical planning for RAPN, showcasing improvements both qualitatively and quantitatively. It opens potential avenues for further research on the application of 3D modeling in various urologic surgeries.