Robot-assisted partial nephrectomy of initial cases using a 3D square-block type kidney model

Yamazaki, Masahiro; Takayama, Tadateru; Fujisaki, Akira; Kamimura, Tomoki; Mashiko, Toshihiro; Fujimura, Tetsuya

doi:10.21037/tau.2019.12.31

Cited by 8 publications

(10 citation statements)

References 20 publications

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“…According to a previous article (7), each final printed model was actual size and had a square-block structure so that the inside could be seen (see Figure 1 for representative images). In the model, arteriovenous arterioles could be reproduced up to the tertiary branches and the branching of the quadratic branches.…”

Section: Three-dimensional Modelmentioning

confidence: 99%

“…In a report using 3D-printed soft-tissue physical models as preoperative simulation in 7 cases, it was also reported that bleeding was reduced (3). In this study, we describe the creation of a novel, simple, and inexpensive 3D-printed model of the kidney that contains the minimal anatomical information required for RAPN (e.g., the tumor, artery, vein, and urinary tract) (7). We aimed to determine the usefulness of this model during initial experience with RAPN and whether its use would contribute to the achievement of TRIFECTA, defined as the absence of perioperative complications, positive surgical margins, and a WIT of <25 min.…”

Section: Introductionmentioning

confidence: 99%

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Utilization of a three-dimensional printed kidney model for favorable TRIFECTA achievement in early experience of robot-assisted partial nephrectomy

et al. 2020

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Background: This retrospective study aimed to investigate whether a three-dimensional (3D) model would improve the achievement of TRIFECTA, which was defined as the absence of perioperative complications and positive surgical margins and a warm ischemia time of <25 minutes, during robot-assisted partial nephrectomy (RAPN). Methods: Prior to RAPN, a 3D-square type kidney model was prepared and used for all RAPN procedures in patients with T1a renal cell carcinoma (RCC) treated at a single center between March 2016 and April 2019. All RAPN procedures were performed by a single surgeon. Results: The study included 50 patients, of whom 22, 24, and 4 had low-, intermediate-, and high-risk R.E.N.A.L Nephrometry scores, respectively. The TRIFECTA achievement rate was 86.0%, and transfusion or conversion to radical nephrectomy was not required in any of the patients. Only one Clavien-Dindo grade 3 complication was reported-a pseudoaneurysm that required embolism. The TRIFECTA achievement rate was independent of the R.E.N.A.L Nephrometry scores and the surgeon's experience level (25 cases each of early and advanced experience).Conclusions: The 3D model contributed to the achievement of TRIFECTA during RAPN performed by a less-experienced surgeon. These findings should be further evaluated in studies involving a larger number of cases and surgeons.

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Section: Three-dimensional Modelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utilization of a three-dimensional printed kidney model for favorable TRIFECTA achievement in early experience of robot-assisted partial nephrectomy

et al. 2020

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“…We used a UP plus2 (Beijing Tiertime Technology Co., Ltd., Beijing, China) 3D printer, which is a Fused Deposition Modeling type of 3D printer that utilizes acrylonitrile butadiene styrene resin to make the 3D kidney models as described in previous studies [8,9]. The Standard Triangulated Language (STL) data from contrast-enhanced CT scans or plain MRI were prepared by a radiology technologist.…”

Section: Development Of the 3d Modelmentioning

confidence: 99%

A retrospective study of using a three-dimensional printed kidney model to evaluate R.E.N.A.L. nephrometry score: an educational tool to improve the diagnostic accuracy of urology residents

Yamazaki

Takayama²,

Fujisaki

et al. 2020

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Background The R.E.N.A.L. nephrometry scoring system is used to evaluate the complexity of renal tumors; however, inconsistency among evaluators, especially junior physicians, is an issue. The objective of the study was to evaluate whether it is useful for junior physicians to use a three-dimensional (3D) kidney model when evaluating the R.E.N.A.L. nephrometry score. Methods An expert and four urology residents retrospectively evaluated the R.E.N.A.L. nephrometry scores of 64 renal tumors (62 patients) which underwent robot-assisted partial nephrectomy at our hospital. The expert evaluated 64 R.E.N.A.L. nephrometry scores with computed tomography (CT) scan imaging, while four residents evaluated 32 cases using only CT and the other 32 cases using CT and 3D kidney model. Consistency between the expert and residents was assessed by Cohen’s kappa score. Patient-specific 3D kidney models were created in a gird style using a 3D printer based on the CT or magnetic resonance imaging of the patient. Results For all four residents, the accuracy of the overall R.E.N.A.L. nephrometry score was significantly higher by 3D model and CT than CT only (p < 0.001). Regarding individual components of the R.E.N.A.L. nephrometry score, the accuracy of “E,” “N,” “A,” and “L” scores was higher by 3D model and CT than by CT only (p = 0.020–0.089). Conclusion Patient-specific 3-D printed kidney model would improve the resident’s understanding of renal tumor complexity and could be an important educational tool for residents.

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“…The procedure initially evolved from open PN (OPN) to laparoscopic PN (LPN), while in recent years, robot-assisted PN (RAPN) has become more common. Progress towards less invasive and safer surgery has been steady, supported by technological development and ingenuity such as in the use of 3D models (3)(4)(5). One of the most stressful and life-threatening complications for patients who undergo PN is renal artery pseudoaneurysm (RAP) (6).…”

Section: Introductionmentioning

confidence: 99%

“…R.E.N.A.L. nephrometry score, median[IQR, range] 7[3,[4][5][6][7][8][9][10] R.E.N.A.L. nephrometry score, low[4][5][6]/moderate[7][8][9]/high[10][11][12]IQR, interquartile range; BMI, body mass index; ASA-PS, American Society of Anesthesiologists physical status; eGFR, estimated glomerular filtration rate; R.E.N.A.L., radius (tumor size as maximal diameter), exophytic/endophytic properties of tumor, nearness of tumor deepest portion to collecting system or sinus, anterior/posterior descriptor and location relative to polar line; RCC, renal cell carcinoma.Transl Androl Urol 2021 | https://dx.doi.org/10.21037/tau-21-384 © Translational Andrology and Urology.…”

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confidence: 99%

Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy

et al. 2021

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Background: We assessed the natural history of renal artery pseudoaneurysm (RAP) after robot-assisted partial nephrectomy (RAPN).Methods: From May 2016 to September 2020, 106 patients underwent RAPN for renal tumors at our institution. Among 100 patients, excluding 6 who were ineligible for contrast-enhanced computed tomography (CE-CT), 4 underwent renal artery selective embolization (RAE), of which 2 cases were emergency RAE within 7 days after RAPN and the other 2 were prophylactic RAE 8 or more days after RAPN. In 98 patients examined for the clinical course of asymptomatic RAP managed by surveillance, excluding the 2 who underwent emergency RAE, routine CE-CT was performed at 7 days, 1 month and 3 months after RAPN. Factors influencing the occurrence of RAP among these 98 patients, including the 2 who underwent emergency RAE and excluding the 2 who underwent prophylactic RAE, were analyzed by logistic regression analysis. Results: Median [interquartile range (IOR), range] observation period, age, radiographic tumor size, and maximum diameter of RAP were 20.8 (23.9, 3.0-57.6) months, 63 (18, 22-84) years, 23 (11, 9-48) mm, and 6.6 (5.2, 3.0-16.0) mm, respectively. CE-CT detected 28 RAPs in 23 (23.0%) of 100 patients by 7 days after RAPN and routine CE-CT detected 25 RAPs in 21 (21.4%) of 98 patients excluding 2 who underwent emergency RAE at 7 days after RAPN. RAP was diagnosed by routine CE-CT in 21 (21.4%), 1 (1.0%), and 0 (0%) patients at 7 days, 1 month, and 3 months after RAPN, respectively. In univariate analysis, age [odds ratio (OR) 0.144: 69-84 vs. 22-56 years old, P=0.0179], R.E.N.A.L [radius (tumor size as maximal diameter), exophytic/endophytic properties of tumor, nearness of tumor deepest portion to collecting system or sinus, anterior/posterior descriptor and location relative to polar line] nephrometry score (OR 1.374, P=0.0382), warm ischemic time (OR 1.085, P=0.0393), and renorrhaphy time (OR 1.055, P=0.0408) were significantly associated with the occurrence of RAP. In multivariate analysis, only age (OR 0.124, P=0.0148) was a significant factor.Conclusions: Asymptomatic RAP up to 15 mm in diameter resolved spontaneously 3 months after RAPN.Young age (under 56 years) may be a factor in the development of RAP.

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Robot-assisted partial nephrectomy of initial cases using a 3D square-block type kidney model

Cited by 8 publications

References 20 publications

Utilization of a three-dimensional printed kidney model for favorable TRIFECTA achievement in early experience of robot-assisted partial nephrectomy

Utilization of a three-dimensional printed kidney model for favorable TRIFECTA achievement in early experience of robot-assisted partial nephrectomy

A retrospective study of using a three-dimensional printed kidney model to evaluate R.E.N.A.L. nephrometry score: an educational tool to improve the diagnostic accuracy of urology residents

Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy

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