Komai Yoshinobu, Sugimoto Maki, Gotohda Naoto, Matsubara Nobuaki, Kobayashi Tatsushi, Sakai Yasuyuki, Shiga Yoshiyuki, Saito Norio
Department of Urology, National Cancer Center Hospital East, Chiba, Japan.
Department of Gastroenterology, Kobe University Graduate School of Medicine, National University Corporation, Hyogo, Japan.
Urology. 2016 May;91:226-33. doi: 10.1016/j.urology.2015.11.060. Epub 2016 Feb 23.
To report our initial experience with a novel style of 3-dimensional (3D) printed kidney, which we call "4D" surgical navigation in minimally invasive off-clamp partial nephrectomy (PN).
Ten patients with a R.E.N.A.L. nephrometry score ≥8 renal mass underwent minimally invasive off-clamp PN navigated with the aid of a patient-specific 3D printed kidney. To enhance the advantage of a 3D printed organ, we herein designed our 3D printed kidneys so that the tumor and its margin could be removed. This tumor removability allowed surgeons and patients to preoperatively visualize both the pre- and posttumor-resection kidney status, which we termed "4D" surgical navigation. Before patients consented to surgery, the surgical procedure and perioperative risks were explained to each patient using the patient-specific 3D printed kidney; subsequently, surgeons asked patients whether the 3D printed kidney model had helped them better understand their surgery than they would have without the model.
All minimally invasive off-clamp PNs were successfully completed with acceptable perioperative outcomes and negative surgical margins. The 3D printed tumors together with their margins were nearly identical to the surgical specimens. All patients responded that their specific 3D printed kidney models had helped them understand their disease and the operations they underwent.
This is the first report of a novel 3D printed organ style, which we termed "4D" surgical navigation. Use of the current 3D printed kidney models helped surgeons to perform minimally invasive off-clamp PN in complex tumor cases and also helped patients to more fully understand the operation.
报告我们在一种新型三维（3D）打印肾脏方面的初步经验，我们将其称为微创非阻断性部分肾切除术（PN）中的“4D”手术导航。
10例肾计量评分（R.E.N.A.L.）≥8分的肾肿物患者接受了借助患者特异性3D打印肾脏进行导航的微创非阻断性PN。为增强3D打印器官的优势，我们在此设计了3D打印肾脏，以便能够切除肿瘤及其边缘。这种肿瘤可切除性使外科医生和患者能够在术前直观看到肿瘤切除前后的肾脏状态，我们将其称为“4D”手术导航。在患者同意手术前，使用患者特异性3D打印肾脏向每位患者解释手术过程及围手术期风险；随后，外科医生询问患者3D打印肾脏模型是否比没有该模型时能让他们更好地理解手术。
所有微创非阻断性PN均成功完成，围手术期结果可接受，手术切缘阴性。3D打印的肿瘤及其边缘与手术标本几乎完全相同。所有患者均表示其特异性3D打印肾脏模型帮助他们了解了自己的疾病及所接受的手术。
这是关于一种新型3D打印器官样式即我们所称的“4D”手术导航的首次报告。使用当前的3D打印肾脏模型有助于外科医生在复杂肿瘤病例中实施微创非阻断性PN，也有助于患者更全面地理解手术。
