Clinical Value of Patient-Specific Three-Dimensional Printing of Kidney Before Partial Nephrectomy: A Qualitative Assessment

Abstract

Objectives: To qualitatively assess the clinical usefulness of patient-specific high-fidelity three-dimensional (3D) print model of kidney before partial nephrectomy (PN) and to identify subset domains where it may help in clinical terms. Materials and Methods: Thirteen 3D models were printed for tumors having RENAL nephrometry score of ‡8. Their usage for PN was assessed prospectively using a qualitative questionnaire to be answered on a Likert scale of 1-10. The questions focused on realistic resemblance, preoperative dry surgical run, intertest comparison, surgical impact, and overall beneficence domains as perceived by primary surgeons with respect to surgical conduct during PN. Results: Mean RENAL score was 9.15 (8-11). Models were rated high (9.07 -0.86) for realistic resemblance domain and were rated better than contrast-enhanced computed tomography (CECT) (8.38 -0.87) and intraoperative ultrasonography (8.07 -1.26) for orientation regarding resection margins. A further marginal improvement to 8.2 -0.84 was noted against ultrasound where surgeon did a dry cut preoperatively. Use of superselective arterial approach in four, precise awareness about dissection of a major vessel in four, retroperitoneoscopic approach in one, and surgical margin awareness in three were directly attributed to the model. Overall utility of having a model printed was rated high (8.23 -1.3). Conclusion:The 3D print models of complex renal tumors have high realistic resemblance to actual patient's anatomy. They were rated better than preoperative CECT or intraoperative ultrasonography for orientation regarding surgical resection margins. It may also help change or modify the surgical plan in a subset of patients with a potential to improve overall outcomes in these complex cases.

Factors affecting the use of a three‐dimensional model during robot‐assisted partial nephrectomy

“…A randomized study 4 examining the use of 3DVR for surgical planning of RAPN found reductions in operative time (odds ratio [OR], 1.00; 95% CI, 0.37–2.70; estimated OR, 2.47), EBL (OR, 1.98; 95% CI, 1.04–3.78; estimated OR, 4.56), clamping time (OR, 1.60; 95% CI, 0.79–3.23; estimated OR, 11.22), and length of hospital stay (OR, 2.86; 95% CI, 1.59–5.14; estimated OR, 5.43). Furthermore, a report that assessed the usefulness of 3D models preoperatively and intraoperatively for difficult RAPNs with questionnaires rated 3D models higher than CT or ultrasound for surgical resection margin orientation 13 . These reports 4,13 indicate that 3DVRs and 3D models are effective in PN.…”

“…Furthermore, a report that assessed the usefulness of 3D models preoperatively and intraoperatively for difficult RAPNs with questionnaires rated 3D models higher than CT or ultrasound for surgical resection margin orientation. 13 These reports 4,13 indicate that 3DVRs and 3D models are effective in PN. However, they do not assess the extent to which the models were required, and there are no such reports in the literature.…”