Identification of Recurrent Anatomical Clusters Using Three-dimensional Virtual Models for Complex Renal Tumors with an Imperative Indication for Nephron-sparing Surgery: New Technological Tools for Driving Decision-making

Piramide, Federico; Pecoraro, Angela; Verri, Paolo; Checcucci, Enrico; Cillis, Sabrina De; Piana, Alberto; Busacca, Giovanni; Manfredi, Matteo; Fiori, Cristian; Porpiglia, Francesco

doi:10.1016/j.euros.2022.02.006

Cited by 8 publications

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References 25 publications

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“…Previous studies have shown that ischemia time and the proportion of preserved renal parenchyma influence postoperative renal function and filtration rate ( 18 , 19 ). In three patients with complex renal tumors and unusual anatomy for which nephron-sparing surgery was indicated, Amparore et al found that 3D virtual model guidance allowed surgeons to plan robotic PN based on preoperative visualization of the anatomical characteristics of the kidney and tumor ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

The influence of 3D renal reconstruction on surgical planning for complex renal tumors: An interactive case-based survey

Azhar

2023

Int. braz j urol.

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Objectives: To evaluate the role of three-dimensional (3D) reconstruction in preoperative planning for complex renal tumors. Materials and Methods: A well-planned questionnaire was distributed among the attending urologists at an international meeting. The questionnaire inquired about demographic data, surgical experience, partial nephrectomy (PN) versus radical nephrectomy (RN), surgical approach, time of ischemia, probability of postoperative urine leakage and positive surgical margins after viewing computed tomography (CT) scans and their respective 3D models of six complex renal tumors. Following the CT scans, attendees were asked to view randomly selected reconstructions of the cases. Results: One hundred expert urologists participated in the study; 61% were aged between 40 and 60 years. Most of them (74%) were consultants. The overall likelihood of PN after viewing the 3D reconstructions significantly increased (7.1±2.7 vs. 8.0±2.2, p<0.001), the probability of conversion to RN significantly decreased (4.3±2.8 vs. 3.2±2.5, p<0.001), and the likelihood of urine leakage and positive surgical margins significantly decreased (p<0.001). Preference for the open approach significantly decreased (21.2% vs. 12.1%, p<0.001), while selective clamping techniques significantly increased (p<0.001). After viewing the 3D models, low expected warm ischemia time and estimated blood loss were significantly preferred by the respondents (p<0.001). Surgical decision change was significantly associated with performance or participation in more than 20 PNs or RNs annually [3.25 (1.98-5.22) and 2.87 (1.43-3.87), respectively]. Conclusions: 3D reconstruction models play a significant role in modifying surgeons' strategy and surgical planning for patients with renal tumors, especially for patients with stronger indications for a minimally invasive and/or nephron-sparing approach.

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Section: Discussionmentioning

confidence: 99%