A Vanderbilt Institute for Surgery and Engineering (VISE) team is developing an image guidance interface for the da Vinci robotic surgery system to make partial kidney removal a less invasive “gold standard” when small tumors are involved.
In such cases, removing part of a kidney with minimally invasive robotic surgery is often best for a patient’s recovery and health, but many surgeons hesitate to do so because the robotic partial nephrectomy procedure is so complex.
The team, which includes biomedical and mechanical engineers and a urologic surgeon, and has received a four-year, $1.4 million National Institutes of Health (NIH) grant to develop enhanced software for a “surgical GPS” system to provide intraoperative guidance to surgeons.
With a three-dimensional map of subsurface tumors, delicate blood vessels and other structures before they make incisions, surgeons can cut in exactly the right place.
“It’s our goal to make minimally invasive partial nephrectomy the gold standard for how patients with appropriate kidney masses are cared for surgically, as clinical evidence shows it should be,” said S. Duke Herrell, M.D., professor of Urologic Surgery, Biomedical and Mechanical Engineering, and director of Minimally Invasive Urologic Surgery and Robotics at Vanderbilt University Medical Center.
“This innovation has the potential to dramatically enhance long-term outcomes and quality of life for patients by preserving kidney function and saving lives by more accurately removing masses and reducing positive tumor margin rates,” he said.
According to National Cancer Institute statistics, an estimated 64,000 new kidney cancer cases will be diagnosed and more than 14,000 deaths will occur in the United States in 2017. The rate of new kidney cancers has been rising since the 1990s, although this has leveled in recent years. Part of the increase was likely due to improved imaging that detected tumors that might not have been found otherwise, Herrell said.
VUMC has six da Vinci robotic surgery systems, including two of the newest models delivered in September. More than 4,000 da Vinci robotic surgery systems are in use worldwide.
Herrell, Robert Webster III, associate professor of mechanical and electrical engineering, and Michael Miga, Harvie Branscomb Professor and professor of biomedical engineering, lead the research team. All are members of the VISE Steering Committee and key founders of VISE.
“The da Vinci robot sits in the Medical Center operating rooms,” Webster said. “Engineering students and post-doctoral researchers working on this project will go there to collect data. Then, they’ll be in my lab in Olin Hall, processing data and writing algorithms. VISE helps facilitate that.
“Also, the proximity of the Medical Center and the Engineering School at Vanderbilt is unique. With just a five-minute walk, we can be at the operating room. It’s just not that way almost anywhere else in the world,” Webster said.
The team will use a novel clinical testing approach in which one surgeon performs a procedure using the da Vinci system; another physician tests the new image guidance display on a parallel da Vinci surgeon console but doesn’t perform any surgical actions. The combination will provide information on the image guidance accuracy without impacting the surgery itself. Once the software is developed and tested, the group plans to move forward with a randomized, multi-institutional study of the technology.
Herrell, who performed the first robotic partial nephrectomy at VUMC in 2009, is among a small number of U.S. urologic surgeons who handle large numbers of these procedures. Many surgeons remain hesitant to provide these less invasive but more precise procedures without a direct imaging system to help navigate complex vessel and tumor anatomy, Herrell said.
“CT and MRI scans provide great information before the case, similar to a good map, but we lack methods to use them optimally in real time in the operating room,” said Herrell. “The best analogy is that when I was young, my family drove around with a big road map atlas. The maps might be 5-10 years out of date, and we had no idea where hazards might be. Now, we have real-time navigation and traffic apps that warn us when there is a pothole 20 feet ahead and help guide us to the best routes. People don’t drive using maps anymore. Everything is about immediate information.”
Herrell began working on this concept several years ago with Robert Galloway, a retired biomedical engineering professor. NIH funding for their grant proposal was imminent when federal research dollars were reduced. Herrell received financial support through VISE to be a physician-in-residence in 2016, allowing him to work one day a week in an engineering laboratory and push forward on the grant. The research team credits VISE and the support of the leadership of both VUMC and Vanderbilt University for the project’s progress from concept to funding.
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