3D Kidney Models Facilitate Robotic Surgery

A Department of Urology and the Jefferson Health Design Lab Collaboration

By Drs. Costas Lallas, Abhay Singh and Leonard Gomella

Kidney cancer often presents as an incidental finding during imaging studies for other conditions. Over time, the standard of care for surgical management of small renal masses (i.e. < 4 cm) has become more focused on renal parenchyma sparing techniques such as using partial nephrectomy. Surgeons in Jefferson’s Department of Urology have been performing partial nephrectomy for decades using standard open surgical techniques. Laparoscopic urologic surgery pioneered at Jefferson and other centers in the 1990’s ushered in the development of new Minimally Invasive Surgery (MIS) techniques. Today, those advances continue with most MIS for renal masses being performed using the latest surgical robotic technology.

There have been ongoing efforts into improving outcomes for this procedure. Robotic partial nephrectomy is a technically complex surgery in which the critical steps of removing the tumor and reconstructing the kidney must be done expeditiously as the blood supply of the kidney is temporarily clamped during this time. Therefore, tools to help optimize this surgery can result in meaningful improvements in the patient’s procedure and recovery. Detailed understanding of the three-dimensional anatomy of the kidney and the exact location of the tumor and blood vessels can facilitate the procedure. Recently, the urologic surgeons in the Department of Urology have begun a collaboration with Jefferson’s Health Design Lab to create 3D printed models of patients’ kidneys with their tumor or tumors in preparation for their surgery. These 3D kidney models are proving to be a very useful tool.

After a patient decides for surgery, the Health Design Lab team works to create a 3D model from the patient’s cross-sectional imaging, which is either a CT or MRI. This model includes the kidney, its vasculature, the collecting system and the mass to be resected. While 3D model printing is not new, the Health Design Lab at Thomas Jefferson University has mastered the quality of the prints by employing the necessary skills to interpret the imaging and segment the critical features to facilitate the printing of a high quality 3D model.

Distinct coloring is used in the models. In the example shown, the tumor is green while the remainder of the kidney is white, with the arterial blood supply red, and the venous system blue. SKMC class of 2023 medical students Reilly Scott and Samuel Morano work with Jefferson radiologist Dr. Vishal Desai, Assistant Professor of Radiology to accurately segment the model based on the imaging. This also includes the relationship of the tumor to the renal collecting system, which further enhances the utility of the model when the kidney is being reconstructed. Dr. Robert Pugliese is Director of Innovation Design for Jefferson and Jefferson Health, and is co-founder and managing director of the Jefferson Health Design Lab. Dr. Pugliese and his Health Design Lab members Alice Karp and Kaitlyn Boyd format and print the models, taking the extra effort to slice the model in 2 pieces so that the surgical team can appreciate where and how deeply the tumor invades.

According to Dr. Pugliese, “Pretty much anything is possible with 3D printing today. While 3D printing technology isn’t new, it has rapidly advanced in recent years making it now accessible and affordable while also increasing in quality and usability. The magic, however, really is putting these tools in the hands of experts and using our design methods to create a model that does not cost much to produce and is designed for optimal value to its users.”

With these tangible models, the surgical team is better able to plan pre-operatively. The models provide a clearer understanding of the location of the tumor and the kidney’s blood supply helping the surgeon plan the dissection of the kidney and its blood supply. It also helps with planning how to reconstruct the resulting defect in the kidney. The models are especially helpful in complex procedures when the tumor abuts critical renal structures or when there is a complicated vasculature system to the kidney (for example multiple arteries or veins). They also go a long way toward the education of medical students and urology residents in understanding the cross-sectional imaging of the kidney. It has become standard practice for the Urology team to review the model together before the surgery and to reference it during the operation itself.

The model is also a powerful learning tool in helping patients understand their surgery. Patients are shown their 3D printed models before their surgery along with an explanation of the relevant anatomy, by a member of the Urology team. After holding and examining the model, patients often remark that they now

Dr. Joseph Izes counselling a patient before robotic partial nephrectomy using her generated 3D kidney tumor model.

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