Dual soft-tissue perfusion was confirmed in most specimens at the nasal, central face, and maxilla. The inclusion of the maxilla in the design of a facial composite allotransplant demands bilateral vascular pedicles based on the internal maxillary arteries. The authors highlight a procurement strategy for design of such flaps.
INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy (RAPN) is a difficult procedure with risk of significant perioperative complications. We implemented the use of preoperative imaging for three-dimensional(3D) reconstructions for surgical planning and intraoperative guidance.The objective was to evaluate the impact of intraoperative guidance with 3D model reconstructions on perioperative outcomes of RAPN.METHODS: We conducted a retrospective analysis of all patients who underwent RAPN for kidney tumor by three high-volume expert surgeons from academic centers. Clinical data were collected prospectively after written consent into the French kidney cancer network database UroCCR(NCT03293563). Our cohort was divided in two groups: 3D-Image guided RAPN group(3D-IGRAPN) and control group. A propensity score according to age, preoperative renal function and RENAL tumor complexity score was used. Both surgical techniques were compared in terms of perioperative outcomes.RESULTS: The initial study cohort included 230 3D-IGRAPN and 415 control RAPN. Before propensity-score matching, patients in the 3D-IGRAPN group had a larger tumor(4.3 cm vs 3.5 cm, p<0.001) and higher RENAL complexity score(9 vs 8, p<0.001). Following propensity-score matching, there were 157 patients in both groups. The rate of major complications was lower for patients in the 3D-IGRAPN group (3.8% vs 9.5%, p[0.04). The median percentage of eGFR variation recorded at first follow-up was lower in the 3D-IGRAPN group(-5.6% vs -10.5%, p[0.002). The trifecta achievement rate was higher in the 3D-IGRAPN group(55.7% vs 45.1%; p[0.005).CONCLUSIONS: Three-dimensional kidney reconstructions allow reliable pre-operative planning and intraoperative surgical guidance which could lower risk of complications and improve perioperative clinical outcomes of RAPN.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.