Artificial Intelligence-Based Hyper Accuracy Three-Dimensional (HA3D®) Models in Surgical Planning of Challenging Robotic Nephron-Sparing Surgery: A Case Report and Snapshot of the State-of-the-Art with Possible Future Implications

Abstract

Recently, 3D models (3DM) gained popularity in urology, especially in nephron-sparing interventions (NSI). Up to now, the application of artificial intelligence (AI) techniques alone does not allow us to obtain a 3DM adequate to plan a robot-assisted partial nephrectomy (RAPN). Integration of AI with computer vision algorithms seems promising as it allows to speed up the process. Herein, we present a 3DM realized with the integration of AI and a computer vision approach (CVA), displaying the utility of AI-based Hyper Accuracy Three-dimensional (HA3D®) models in preoperative planning and intraoperative decision-making process of challenging robotic NSI. A 54-year-old Caucasian female with no past medical history was referred to the urologist for incidental detection of the right renal mass. Preoperative contrast-enhanced abdominal CT confirmed a 35 × 25 mm lesion on the anterior surface of the upper pole (PADUA 7), with no signs of distant metastasis. CT images in DICOM format were processed to obtain a HA3D® model. RAPN was performed using Da Vinci Xi surgical system in a three-arm configuration. The enucleation strategy was achieved after selective clamping of the tumor-feeding artery. Overall operative time was 85 min (14 min of warm ischemia time). No intra-, peri- and post-operative complications were recorded. Histopathological examination revealed a ccRCC (stage pT1aNxMx). AI is breaking new ground in medical image analysis panorama, with enormous potential in organ/tissue classification and segmentation, thus obtaining 3DM automatically and repetitively. Realized with the integration of AI and CVA, the results of our 3DM were accurate as demonstrated during NSI, proving the potentialities of this approach for HA3D® models’ reconstruction.