Chen Yuanbo, Li Hulin, Wu Dingtao, Bi Keming, Liu Chunxiao
Department of Urology, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530001, Guangxi, People's Republic of China,
World J Urol. 2014 Dec;32(6):1493-9. doi: 10.1007/s00345-013-1222-0. Epub 2013 Dec 12.
Construction of three-dimensional (3D) model of renal tumor facilitated surgical planning and imaging guidance of manual image fusion in laparoscopic partial nephrectomy (LPN) for intrarenal tumors.
Fifteen patients with intrarenal tumors underwent LPN between January and December 2012. Computed tomography-based reconstruction of the 3D models of renal tumors was performed using Mimics 12.1 software. Surgical planning was performed through morphometry and multi-angle visual views of the tumor model. Two-step manual image fusion superimposed 3D model images onto 2D laparoscopic images. The image fusion was verified by intraoperative ultrasound. Imaging-guided laparoscopic hilar clamping and tumor excision was performed. Manual fusion time, patient demographics, surgical details, and postoperative treatment parameters were analyzed.
The reconstructed 3D tumor models accurately represented the patient's physiological anatomical landmarks. The surgical planning markers were marked successfully. Manual image fusion was flexible and feasible with fusion time of 6 min (5-7 min). All surgeries were completed laparoscopically. The median tumor excision time was 5.4 min (3.5-10 min), whereas the median warm ischemia time was 25.5 min (16-32 min). Twelve patients (80 %) demonstrated renal cell carcinoma on final pathology, and all surgical margins were negative. No tumor recurrence was detected after a media follow-up of 1 year (3-15 months).
The surgical planning and two-step manual image fusion based on 3D model of renal tumor facilitated visible-imaging-guided tumor resection with negative margin in LPN for intrarenal tumor. It is promising and moves us one step closer to imaging-guided surgery.
构建肾肿瘤的三维（3D）模型，以辅助肾内肿瘤腹腔镜肾部分切除术（LPN）的手术规划及手动图像融合的影像引导。
2012年1月至12月，15例肾内肿瘤患者接受了LPN。使用Mimics 12.1软件基于计算机断层扫描重建肾肿瘤的3D模型。通过肿瘤模型的形态测量和多角度视觉视图进行手术规划。两步手动图像融合将3D模型图像叠加到2D腹腔镜图像上。术中超声验证图像融合。进行影像引导下的腹腔镜肾门阻断和肿瘤切除。分析手动融合时间、患者人口统计学资料、手术细节及术后治疗参数。
重建的3D肿瘤模型准确呈现了患者的生理解剖标志。手术规划标记成功标记。手动图像融合灵活可行，融合时间为6分钟（5 - 7分钟）。所有手术均通过腹腔镜完成。肿瘤切除中位时间为5.4分钟（3.5 - 10分钟），而热缺血中位时间为25.5分钟（16 - 32分钟）。12例患者（80%）最终病理显示为肾细胞癌，所有手术切缘均为阴性。中位随访1年（3 - 15个月）后未检测到肿瘤复发。
基于肾肿瘤3D模型的手术规划和两步手动图像融合有助于在LPN中对肾内肿瘤进行可视影像引导下的肿瘤切除，切缘阴性。这很有前景，使我们向影像引导手术又迈进了一步。
