Role and Utility of Mixed Reality Technology in Laparoscopic Partial Nephrectomy: Outcomes of a Prospective RCT Using an Indigenously Developed Software

OBJECTIVE: To develop a software for mixed reality (MR) anatomical model creation and study its intraoperative clinical utility to facilitate laparoscopic partial nephrectomy. MATERIALS AND METHODS: After institutional review board approval, 47 patients were prospectively randomized for LPN into two groups: the control group (24 patients) underwent operation with an intraoperative ultrasound (US) control and the experimental group (23 patients) with smart glasses HoloLens 2 (Microsoft, Seattle, WA, USA). Our team has developed an open-source software package called “HLOIA,” utilization of which allowed to create and use during surgery the MR anatomical model of the kidney with its vascular pedicle and tumor. The study period extended from June 2020 to February 2021 where demographic, perioperative, and pathological data were collected for all qualifying patients. The objective was to assess the utility of a MR model during LPN and through a 5-point Likert scale questionnaire, completed by the surgeon, immediately after LPN. Patient characteristics were tested using the chi-square test for categorical variables and Student's t-test or Mann–Whitney test for continuous variables. RESULTS: Comparison of the variables between the groups revealed statistically significant differences only in the following parameters: the time for renal pedicle exposure and the time from the renal pedicle to the detection of tumor localization (p < 0.001), which were in favor of the experimental group. The surgeon's impression of the utility of the MR model by the proposed questionnaire demonstrated high scores in all statements. CONCLUSIONS: Developed open-source software “HLOIA” allowed to create the mixed reality anatomical model by operating urologist which is when used with smart glasses has shown improvement in terms of time for renal pedicle exposure and time for renal tumor identification without compromising safety

Робот-ассистированная трансплантация почки. Первый опыт

Kidney transplantation is the preferred renal replacement therapy for patients with end-stage renal disease. Traditional surgical approaches consisting of vascular and urinary outflow reconstruction during kidney transplant have been sufficiently studied and standardized. However, surgical techniques are still evolving. The objective of this clinical report is to focus the attention of kidney transplant surgeons and specialists on the currently trending robot-assisted kidney transplantation (RAKT) as a minimally invasive procedure for surgical treatment of patients with end-stage renal disease. In our first experience, good primary graft function was achieved. This shows that RAKT is a surgical option. With considerable number of surgeries and experience, RAKT outcomes would be improved significantly.Аллотрансплантация почки в настоящее время во всем мире является предпочтительным методом заместительной терапии у пациентов с терминальной стадией поражения почечной функции. Классические хирургические принципы сосудистой реконструкции и создания мочевого оттока при пересадке почки полностью изучены и стандартизированы. Несмотря на это, эволюция хирургической техники все же является непрерывным процессом. Целью данного клинического сообщения является акцентирование внимания хирургов-трансплантологов и специалистов, занятых в лечении реципиентов почек, на отражающем современные тенденции развития хирургии виде робот-ассистированной трансплантации почки (РАТП), как на щадящем методе оперативного лечения пациентов с терминальной стадией поражения почек. Результаты первого опыта в виде хорошей первичной функции трансплантата почки демонстрируют возможность использования РАТП как варианта хирургического вмешательства. Накопление же достаточного пула проведенных операций в значительной степени улучшит результаты использования такого метода лечения

Радикальная простатэктомия в России: особенности периоперационного ведения и нюансы технического исполнения

Despite constant improvements in radical prostatectomy technique, some questions on standardization of both perioperative management stages and surgical intervention itself remain.We conducted an anonymous online survey of 45 oncological urologists from 15 regions of the Russian Federation who are actively involved in the surgical treatment of patients with prostate cancer.According to the results of the survey, there is huge variability associated, to a great extent, with equipment availability in clinics and the lack of sufficient evidence-based information in some matters of perioperative management.A detailed study of each step of surgical treatment, clinical trials, and involvement of professional societies will contribute to the standardization of perioperative management of patients and radical prostatectomy technique. Несмотря на  продолжающееся совершенствование техники радикальной простатэктомии, все  еще есть ряд вопросов по стандартизации этапов периоперационного ведения пациентов и самого оперативного вмешательства. Мы   провели  анонимный онлайн-опрос  45  онкоурологов из  15  регионов  России, активно  занимающихся хирургическим лечением больных раком предстательной железы.По результатам анализа полученных данных выявлена значительная вариативность подходов, связанная в большей степени с техническими возможностями клиник и отсутствием в некоторых вопросах достаточной доказательной базы. Детальное изучение каждого этапа хирургического лечения, проведение клинических исследований с привлечением профессиональных ассоциаций будут способствовать унификации стандартного периоперационного ведения пациентов и техники радикальной простатэктомии

Robot-assisted kidney transplantation. First experience

Kidney transplantation is the preferred renal replacement therapy for patients with end-stage renal disease. Traditional surgical approaches consisting of vascular and urinary outflow reconstruction during kidney transplant have been sufficiently studied and standardized. However, surgical techniques are still evolving. The objective of this clinical report is to focus the attention of kidney transplant surgeons and specialists on the currently trending robot-assisted kidney transplantation (RAKT) as a minimally invasive procedure for surgical treatment of patients with end-stage renal disease. In our first experience, good primary graft function was achieved. This shows that RAKT is a surgical option. With considerable number of surgeries and experience, RAKT outcomes would be improved significantly