IntroductionFor the procedure retroperitoneoscopic ureterolithotomy, the problems of access choice and thus visualization with utilizing minimally invasive surgical access (either with gasless single port method or gas insufflation) are solved. The decisions are based on the method of presurgery planning, grounded on matching the patient with a 3D model of the zone of surgical interest reconstructed according to the results of tomographic examination.Material and methodsWe used a hardware–software complex (HSC) for virtual modeling of the surgery zone and choosing the optimum points for minimally invasive surgical access. The HSC was recruited to choose optimum surgical access, realize presurgery planning, and estimation of the safety of the way of access chosen. The original method of matching the system of coordinates of a virtual model with the patient was offered.Results12 patients with the calculus in the upper part of ureter averaging 11.5 (9–14) mm in size underwent gasless retroperitoneoscopic ureterolithotomy with use of the HSC. Mean age of the patients was 36.4 (25–49) years old. The surgeries lasted an average of 35.5 (25–40) minutes. Blood loss was averaged at 55.0 (30–90) ml. Healing by first intention was registered with all the patients. The mean hospitalization time was 6.0 (4–7) days. There were neither any complications nor difficulties, nor conversions from incorrectly chosen surgical access.ConclusionsThe choice of the optimum surgical access according to the results of a virtual 3D model of the operation zone, matching the system of coordinates of the model with patient concurrence, and presurgery planning, was effective in cases of gasless single port and with gas insufflation retroperitoneoscopic ureterolithotomy.
IntroductionThe use of computer navigation systems is a new and actively explored method used for surgical procedures concerning the abdominal and retroperitoneal organs. In this paper, we propose an original hardware – software complex, which forms a virtual body model, based on preoperative computer tomography data, transmitted to the operating screen monitor using a surgical navigation system, involving a mechanical digitizer.Material and methodsDuring a laparoscopic procedure, a three-dimensional (3D) model of a kidney with a tumor was used to obtain additional information on the primary or secondary monitor or for combining the virtual model and video images on the main or additional monitor in the operating room. This method was used for laparoscopic partial nephrectomy, where twelve patients were operated with an average age of 45.4 (38–54) years, with clear cell renal cell carcinoma size 27.08 (15–40) mm.ResultsAll patients successfully underwent laparoscopic partial nephrectomy with intraoperative navigation. The mean operative time was 97.2 (80–155) minutes, warm ischemia time – 18.0 (12–25) minutes. Selective clamping of segmental renal arteries was performed in 7 (58.3%) cases, in the remaining 5 (41.6%) cases the renal artery was clamped. There were no serious complications. The average duration of hospital stay was 7.0 (5–10) days.ConclusionsPreliminary results of our clinical study have shown the success of 3D modeling for qualitative visualization of kidney tumors in the course of surgical intervention, both for the surgeon and for the patient to understand the nature of the pathological process.
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