YUORDay24: New technologies for surgeons?

3D models are the future of kidney surgery!

In his lecture “The importance of 3D models for planning and navigation in kidney surgery”, Dr. Daniele Amparore (IT) shared an update on 3D models, including the advantages and current research, as well as the challenges.

According to Dr. Amparore, the 3D virtual models have been developed in generations – I, II, III, and most recently, generation IV, which is the 3DVM. This new model reproduces the real organ textures. The rational for this is to maximise visual concordance between the virtual organ and the real one. This brings the experience a step closer towards the digital twin: automatic selection of intraoperative pictures for the textures with AI.

These 3D virtual models are used in fields of application, such as planning surgery (mixed reality planning, 3D PDF planning, and metaverse planning), and in intraoperative navigation (3D cognitive surgery, and 3D augmented reality surgery).

Dr. Amparore referenced several research papers suggesting the use of 3D models improves patient safety, optimises procedure efficacy, and maximises surgical success:

• The ‘ERUS International validation study’ and ‘Three-dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores’ both demonstrated lower complexity and higher accuracy in predicting overall and major complications when using 3D models compared to 2D-TC.
• ‘Three-dimensional model-assisted minimally invasive partial nephrectomy: A systematic review with meta-analysis of comparative studies’ illustrated that 3D model guidance during RAPN offered wider use of selective clamping, a higher rate of pure enucleations and a reduced risk of Urinary Collecting System violation.

Dr. Amparore: “Some drawbacks still limit the diffusion of 3D technology in daily practice, such as costs, usability, and evolution (constant technological advancements of 3D technology makes it difficult to standardise). There is a huge cost of human resources and money to develop and further increase the quality of 3D technology, a mutual combination of computer vision and deep learning (AI) segmentation automatic tools are to be used to speed up 3DVM production.”

Regarding usability, Dr. Amparore stated that there is a lack of knowledge to handle 3D technology due to digital literacy by its potential users (surgeons). To address this, dedicated courses to teach 3D models production, handling, and intraoperative overlapping (AR) during partial nephrectomy on pig models, which includes a CT scan of the pig model, 3DVM production, theoretical section, and 3D handling training.

AI is the new trend

In his lecture ‘Artificial intelligence for prostate cancer: Imaging to histology’ Dr. Kevin Kaulanjan (FR) began with a quote from Dan Ariely, “Artificial intelligence is like teenage sex, everyone talks about it, but nobody really knows how to do it, and everyone thinks everyone else is doing it”.

Dr. Kaulanjan: “You have to keep a critical opinion of the result when using AI. Here are four important factors to keep in mind when using AI: Define quality and metrics, data quality and preprocessing, validation and cross-validation, and clinical validation.”

“AI is a revolution in prostate cancer but remember we are still the captain; AI is the first officer”.

And the winners are…

YUORDay24 concluded with a showdown between the three finalists of the EAU Guidelines Cup, as well as award presentations honouring excellence in urology research.

After an exciting battle of knowledge, Dr. João Mendes Carvalho (PT) was crowned the 2024 EAU Guidelines Cup winner! The other two finalists were Dr. Michał Czerwaty (PL), Dr. Julie Devos (BE).

First prize for the “Best Abstract by a Resident” went to Dr. Alexander Light (GB) for “The Trans-Atlantic recommendations for prostate gland evaluation with MRI after focal therapy (TARGET) international consensus recommendations” (A0671). Second prize went to Dr. Federico Belladelli (IT) for his work “Duration of untreated ED is associated with overall impoverishment of male sexual function” (A1099). Third prize went to Dr. Mohamad Berjaoui (CA) for his research “Water vs. Water II 5-year update: comparing aquablation therapy for benign prostatic hyperplasia in 30-80 cc and 80-150 cc prostates” (A0167).

This article reports on a small part of the full day session but you can (re)watch the full presentations, please go to EAU24 Resource Centre.