Background

Available technologies could avoid global ischemia for the removal of a renal tumor.

Objective

To present hyperaccuracy three-dimensional (HA3D) reconstruction during robot-assisted partial nephrectomy (RAPN) and compare its efficacy in sponsoring successful selective clamping of renal arterial branches during RAPN.

Design, setting, and participants

Patients undergoing RAPN (January 2016–July 2017) for renal mass PADUA score ≥10 who underwent abdominal computed tomography scan with angiography. Since February 2017 HA3D reconstruction was performed.

Surgical procedure

HA3D reconstruction-aided RAPN and standard RAPN with selective clamping.

Measurements

Intraoperative variables focusing on the renal arterial pedicle management and success rate of its planned management.

Results and limitations

Thirty-one patients in group no HA3D and 21 in group HA3D. The median (standard deviation) tumor size was 50.9 and 50.8 mm (p = 0.97), and median PADUA scores 10.5 and 11 (p = 0.85) for groups no HA3D and HA3D, respectively. In group no HA3D, a significantly higher number of patients underwent global ischemia (80% vs 24%, p < 0.01). Of note, in 90% of the group HA3D cases, intraoperative management of the renal pedicle was performed as preoperatively planned; in 39% of the group no HA3D cases, management of the renal arterial pedicle was varied intraoperatively (p = 0.04). We disclose the limited sample size and the experimental technique.

Conclusions

Preoperative simulation of selective ischemia was feasible and effective with HA3D reconstruction. In all the RAPN cases performed, selective clamping was successful, avoiding ischemia of the healthy renal remnant. A strict collaboration between urologists and bioengineers is mandatory to improve the technology.

Patient summary

In this report, we found that an accurate three-dimensional reconstruction of the kidney before conservative surgery for renal cancer seems to help in avoiding the global ischemia of the kidney. Further studies are needed to conclude if avoiding a percentage of ischemia to the kidney is clinically relevant.

中文翻译：

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高精度三维重建能够最大程度地提高复杂肾脏肿块机器人辅助部分肾切除术中选择性钳夹的有效性

背景

可用的技术可以避免局部缺血以去除肾脏肿瘤。

客观的

要介绍机器人辅助部分肾切除术（RAPN）期间的超三维三维（HA3D）重建，并比较其在RAPN期间成功成功地选择性夹持肾动脉分支的功效。

设计，设置和参与者

肾质量PADUA评分≥10的接受RAPN的患者（2016年1月至2017年7月）接受了腹部X线断层扫描和血管造影检查。自2017年2月以来，进行了HA3D重建。

手术程序

HA3D重建辅助的RAPN和标准RAPN，具有选择性夹持功能。

测量

术中变量侧重于肾动脉蒂的管理及其计划管理的成功率。

结果与局限性

无HA3D组的31位患者和HA3D组的21位患者。 对于没有HA3D和HA3D的组 ，肿瘤大小的中位数（标准差）为50.9和50.8毫米（p = 0.97），而PADUA的中位数分别为10.5和11（p = 0.85）。在没有HA3D的组中，发生整体缺血的患者明显更多（80％vs 24％，p  <0.01）。值得注意的是，在HA3D组中有90％的患者按术前计划进行了肾蒂的术中管理；在没有HA3D病例的组中，有39％的患者术中改变了肾动脉蒂的处理（p  = 0.04）。我们公开了有限的样本量和实验技术。

结论

用HA3D重建术对选择性缺血进行术前模拟是可行和有效的。在所有进行过的RAPN病例中，成功进行了选择性钳夹，避免了健康肾脏残余物的局部缺血。为了改善技术，泌尿科医师和生物工程师之间必须进行严格的合作。

病人总结

在这份报告中，我们发现在进行肾脏癌保守手术之前，对肾脏进行精确的三维三维重建似乎有助于避免肾脏的整体缺血。是否需要进一步研究得出结论，避免一定比例的肾脏缺血在临床上是否有意义。