Urology Video Journal (Jun 2022)

Step by step three-dimensional virtual models assistance in case of complex robotic partial nephrectomies

  • Angela Pecoraro,
  • Federico Piramide,
  • Paolo Verri,
  • Enrico Checcucci,
  • Sabrina De Cillis,
  • Alberto Piana,
  • Matteo Manfredi,
  • Cristian Fiori,
  • Francesco Porpiglia,
  • Daniele Amparore

Journal volume & issue
Vol. 14
p. 100141

Abstract

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Objective: Nowadays the development of new technologies in urological field allows to perform surgical approaches tailored on the characteristics of each single case. Three-dimensional virtual models (3DVMs) have been developed in the last years to overcome the “building in mind” process that the surgeon should do to perceive the features of the organs in a real human body from CT scan images. Aim of the study is to report our experience regarding the use of 3DVMs in the planning and intraoperative navigation during minimally-invasive nephron sparing surgery (mi-NSS) in highly complex renal tumors. Patients and surgical procedure: We prospectively recorded preoperative, perioperative and functional data of high complex renal tumor who underwent miNSS from August 2017 to August 2021. All patients performed contrast-enhanced CT from which a 3DVM was obtained. Using such technological tools, it was possible to identify three different application field from the planning to the end of the surgery to optimize the success of the procedure. Results: Overall, 79 patients harboring PADUA> 10 unilateral renal masses were prospectively selected from our Institutional database. At CT scan the median clinical size was 50 mm, IQR: [43.5–60]. Concerning intraoperative characteristics, 34.1 and 24.1% of patients underwent selective or clampless NSS. The rate of positive surgical margin (PSM) was 2.5%. and the rate of postoperative complications was 16.5%. The difference between preoperative and postoperative eGFR was not meaningful (21% IQR: [1.8–32.7]). The MIC score was achieved in 87.3% of patients. The major complications rate (Clavien-Dindo> 2) was 2.5%. Conclusions: 3D models represent a useful tool to plan a tailored surgical approach in cases of surgically complex masses. They can be used in different ways, matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase.

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