Objective

3D models are increasingly used as additional preoperative tools for renal surgery. We aim to evaluate the impact of 3D renal models in the assessment of PADUA, RENAL, Contact Surface Area (CSA) and Arterial Based Complexity (ABC) for the prediction of complications after Robot assisted Partial Nephrectomy (RAPN).

Methods and materials

Overall, 57 patients with T1 and 1 patient with T2 renal mass referred to RAPN, were prospectively enrolled. 3D virtual modelling was obtained from 2D computed tomography (CT). Two radiologists recorded PADUA_2D, RENAL_2D, CSA_2D and ABC_2D by evaluation of 2D images; two bioengineers recorded PADUA_3D, RENAL_3D, CSA_3D and ABC_3D by evaluation of the 3D model, using MeshMixer software. To evaluate the concordance between 2D and 3D nephrometry scores, Cohen's j coefficient was calculated. Receiver-operating characteristic (ROC) curves were generated to evaluate the accuracy of 3D and 2D nephrometry scores to predict overall complications. Finally, the impact of 3D model on clamping approach during RAPN was compared to 2D imaging.

Results

PADUA_3D, RENAL_3D, CSA_3D and ABC_3D scores had a significant different distribution compared to PADUA_2D, RENAL_2D, CSA_2D and ABC_2D (all p≤0.03). 2D nephrometry scores may be unchanged, reduced or increased after assessment by 3D models: CSA_3D, PADUA_3D, RENAL_3D and ABC_3D were reduced in14%, 26%, 29% and 16% and increased in 16%, 36%, 38% and 29% of cases, respectively. At ROC curve analysis, PADUA_3D, RENAL_3D and ABC_3D showed were significantly better accuracy to predict complications compared to PADUA_2D, RENAL_2D and ABC_2D. PADUA_3D (OR: 1.66), RENAL_3D (OR: 1.69) and ABC_3D (OR: 2.44) revealed a significant correlation with postoperative complications (all P ≤0.03).

Conclusion

Nephrometry scores calculated via 3D models predict complications after RAPN with higher accuracy than conventional 2D imaging.

中文翻译：

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用 3D 虚拟模型解释肾功能评分，以更好地规划机器人部分肾切除术和预测并发症

客观的

3D 模型越来越多地用作肾脏手术的额外术前工具。我们旨在评估 3D 肾脏模型在评估 PADUA、RENAL、接触表面积 (CSA) 和基于动脉的复杂性 (ABC) 以预测机器人辅助部分肾切除术 (RAPN) 后并发症的影响。

方法和材料

总体而言，前瞻性招募了 57 名 T1 患者和 1 名 T2 肾肿块患者被称为 RAPN。从 2D 计算机断层扫描 (CT) 获得 3D 虚拟建模。两名放射科医生通过评估 2D 图像记录了 PADUA _2D、 RENAL _2D、CSA _2D和 ABC _{2D ；}两名生物工程师记录了 PADUA _3D、 RENAL 3D _、 CSA _3D和 ABC _3D通过使用 MeshMixer 软件评估 3D 模型。为了评估 2D 和 3D 肾功能评分之间的一致性，计算了 Cohen 的 j 系数。生成受试者操作特征 (ROC) 曲线以评估 3D 和 2D 肾功能评分预测总体并发症的准确性。最后，将 3D 模型对 RAPN 期间钳位方法的影响与 2D 成像进行了比较。

结果

_{与 PADUA 2D}、 RENAL _2D、CSA _2D和 ABC _2D相比， PADUA _3D、 RENAL 3D _、 CSA _3D和 ABC _3D评分具有显着不同的分布（均 p≤0.03）。通过 3D 模型评估后，2D 肾功能评分可能保持不变、降低或增加：CSA _3D、PADUA _3D、 RENAL _3D和 ABC _3D分别降低了 14%、26%、29% 和 16%，增加了 16%、36%、38分别为 % 和 29% 的病例。在 ROC 曲线分析中，PADUA _3D、 RENAL _3D和 ABC _3D显示是_{与 PADUA 2D}、 RENAL _2D和 ABC _2D相比，预测并发症的准确性显着提高。PADUA _3D (OR: 1.66)、RENAL _3D (OR: 1.69) 和 ABC _3D (OR: 2.44) 显示与术后并发症显着相关（均P ≤0.03）。

结论

通过 3D 模型计算的肾功能评分预测 RAPN 后的并发症，其准确性高于传统的 2D 成像。