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

Abstract

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.

Three‐dimensional (3D) reconstruction and navigation in robotic‐assisted partial nephrectomy (RAPN) for renal masses in the solitary kidney: A comparative study

“…The evolution from open partial nephrectomy to pure laparoscopic approach and the increasingly accepted RAPN enable surgeons to dissect renal pedicles 21 and choose nonglobal ischemia techniques, which is believed to facilitate 22,23 postoperative renal function preservation. Utilization of a 3D printed kidney model can compensate for a relative lack of surgical experience and led to a high TRIFECTA achievement rate, 24,25 although more large-scale evidence was needed to prove the impact on renal function. 26 In 2008, Ukimura 27 first reported the utilization of AR visualization systems during laparoscopic partial nephrectomy.…”

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

“…Two of the surgeons were new to RAPN, and one had performed 40 cases. We performed RAPN using the same procedures as previously reported 5 . RAPN was conducted using a 4‐arm da Vinci Si® Robotic System (Intuitive Surgical, Sunnyvale, CA, USA), with two or three assistant ports.…”

Current status and challenges of 3D navigation in partial nephrectomy

“…There have also been reports of a significant decrease in warm ischemia time when 3D printed models were employed for preoperative planning and intraoperative navigation [18] . In addition, it has been reported that they are not only useful for patient education but also for resident education, and they are beneficial in achieving the trifecta during the initial implementation of RAPN [19,20] . VR VR, a technology that provides an independent virtual world, is used for preoperative simulation and training in surgical navigation [21] .…”