Three-Dimensional Printing Assisted Laparoscopic Partial Nephrectomy vs. Conventional Nephrectomy in Patients With Complex Renal Tumor: A Systematic Review and Meta-Analysis

Abstract

The purpose of this meta-analysis was to systematically assess the influence of three-dimensional (3D) printing technology in laparoscopic partial nephrectomy (LPN) of complex renal tumors. Methods: A systematic literature review was performed in June 2020 using the Web of Science, PubMed, Embase, the Cochrane library, the China National Knowledge Infrastructure (CNKI), and the Wanfang Databases to identify relevant studies. The data relative to operation time, warm ischemic time, intraoperative blood loss, positive surgical margin, reduction in estimated glomerular filtration rate (eGFR), and complications (including artery embolization, hematoma, urinary fistula, transfusion, hematuria, intraoperative bleeding, and fever) were extracted. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the Stata 12.1 software. A subgroup analysis was performed stratifying patients according to the complexity of the tumor and surgery type or to the nephrometry score. Results: One randomized controlled trial (RCT), two prospective controlled studies (PCS), and seven retrospective comparative studies (RCS) were analyzed, involving a total of 647 patients. Our meta-analysis showed that there were significant differences in operation time, warm ischemic time, intraoperative blood loss, reduction in eGFR, and complications between the LPN with 3D-preoperative assessment (LPN-3DPA) vs. LPN with conventional 2D preoperative assessment (LPN-C2DPA) groups. Positive surgical margin did not differ significantly. Conclusion: The LPN-3DPA group showed shorter operation time and warm ischemic time, as well as less intraoperative blood loss, reduction in eGFR, fewer complications for Jiang et al. 3D Printing and LPN patients with complex renal tumor. Therefore, LPN assisted by three-dimensional printing technology should be a preferable treatment of complex renal tumor when compared with conventional LPN. However, further large-scale RCTs are needed in the future to confirm these findings.

Application of low‐dose CT to the creation of 3D‐printed kidney and perinephric tissue models for laparoscopic nephrectomy

“…Relevant studies have shown that 3D printing-assisted LPN can shorten the operation time and the warm ischemic time and reduce intraoperative blood loss. [23][24][25] These results are consistent with our study. However, these 3D printing models have not demonstrated the occurrence of APF.…”

A Meta-Review about Medical 3D Printing

“…Non-invasive devices are external applications, like 3DP models. The medical fields included are anesthesia [1], cardiology [2][3][4][5][6][7][8][9][10][11][12][13], coloproctology [14], dentistry [15][16][17][18], general surgery [19][20][21][22][23][24][25], health care engineering [26,27], hepatology [28], interventional radiology [29], medical education [30][31][32][33][34], neurosurgery [35][36][37][38][39], oncology [40][41][42][43] and radiation oncology [44][45][46]. Further medical fields included are oral and maxillofacial surgery [47][48][49]<...…”

“…Further medical fields include plastic surgery [93,94], traumatology [95][96][97], urology [98][99][100][101][102] and vascular surgery [103][104][105][106]. The affected organs or organ systems include the aorta [13,103,106], bladder [29], brain [35,37,39], cranium [30, 31, 34, 36, 44, 48-50, 53-55, 82, 84, 86, 91], ear [48, 78-81, 83, 93], female internal genitals [46], heart [2-12, 87, 88, 104], jaw [17, 20, 21, 23, 25, 47-52, 55, 56], kidney [29,41,98,[100][101][102], lip [94], liver [19,22,28], musculoskeletal system [20, 21, 24, 31-33, 38, 43, 57-77, 89, 90, 92, 93, 95-97], prostate [98,99], rectum and colon [14,40,42,45], spine [38,59,68,77,…”

“…Other combinations found were pre-operative planning and teaching [3, 4, 7-9, 12, 14, 20, 24, 25, 28, 34, 35, 37, 38, 51, 55, 58, 62, 77, 79, 84, 86, 88, 104], pre-operative planning, teaching and patient counseling [6, 11, 42, 59, 83, 85, 89, 91, 93-95, 98, 99, 101, 105, 106], teaching [1,[29][30][31][32][33][80][81][82], pre-opertive planning and patient counseling [40,50,65,66,87,100] and patient counseling [68]. The top three countries, with most publications originated from, in alphabetical order, are Australia [1,6,7,16,22,28,45,53,68,99,[101][102][103][104], China [9,30,41,57,60,61,65,69,72,74,75,84,96,105,...…”

Three-Dimensional Physical Model in Urologic Cancer

“…3D-printed models were welcomed during the performance of complex and high-precision surgeries ( Figures 1D,E ). The advantages of the 3D kidney for partial nephrectomy (PN) include shorter operation times and warm ischemia times, less intraoperative blood loss, as well as fewer complications, in comparison to PN with imaging alone ( 9 ). Our previous data revealed that, compared with traditional laparoscopic partial nephrectomy, 3D-printed models can help to reduce the warm ischemia time and the estimated intraoperative blood loss from 29.2 to 24.6 min, and 131.1 ml to 118.7 ml, respectively, in patients with complex renal tumor (R.E.N.A.L score>8) ( 8 ).…”