Choice of surgical access for retroperitoneoscopic ureterolithotomy according to the results of 3D reconstruction of operational zone agreed with the patient: initial experience

Abstract

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.

Virtual simulation, preoperative planning and intraoperative navigation during laparoscopic partial nephrectomy

“…Virtual simulation is increasingly used in medical practice as a combination of the achievements of modern computer technology and medical imaging [8–11]. Creation a 3D model of the organ or area of the surgical intervention based on CT study images allows the combination of different contrast-phase studies, including vascular, parenchymal and excretory which gives the surgeon additional information and is helpful for the patient to understand the essence of the disease [12, 13].…”

Editorial referring to the paper published in this issue on pp. 191–192 Getting access in PNL – eyes wide shut

“…This is still a beta version but more teams are working on similar solutions [5]. The same technology could be used in future generations of simulators.…”

“…Rassweiler et al advocate the use of the iPad for visualization of the pelvicalyceal system, adjacent organs, and their interaction with a needle [ 4 ]. This is still a beta version but more teams are working on similar solutions [ 5 ]. The same technology could be used in future generations of simulators.…”

Virtual guidance of urologic surgery

“…Further refinements focus on accurate assessments of the disease location so the treatment may be targeted, less morbid, yet effective. In this issue of CEJU one of the new methods of ureteral stone positioning in the operating field is presented [ 1 ]. It is based upon data derived from a CT scan, and with the help of a particular software, virtually placed within the body of the patient preoperatively so that the surgery is directed and free from any deviations.…”