Cheng Sida, Li Xinfei, Zhu Weijie, Li Wanqiang, Wang Jie, Yang Jian, Wu Jingyun, Wang He, Zhang Lei, Li Xuesong, Zhou Liqun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Department of Urology, The First College of Clinical Medical Science, Three Gorges University/Yichang Central People's Hospital, Yichang, China.
Transl Androl Urol. 2021 Jan;10(1):125-133. doi: 10.21037/tau-20-1006.
The aim of this study was to evaluate the effectiveness and safety of real-time surgical navigation by three-dimensional (3D) virtual reconstruction models in robot-assisted laparoscopic pyeloplasty (RALP).
Between November 2018 and January 2020, 38 patients with ureteropelvic junction obstruction (UPJO) who underwent RALP were retrospectively enrolled. The operations were assisted in real time by 3D models in 16 patients, while 22 patients underwent surgery without navigation. Based on whether patients had a prior intervention history, crossing vessels or congenital deformities, we further divided them into the "complicated UPJO" cohort and the "regular UPJO" cohort for subgroup analysis. The demographic characteristics, intraoperative parameters, perioperative data and follow-up data were recorded and compared between the groups.
All of the procedures were successfully performed without open or laparoscopic conversion. The mean dissection time to the UPJ was shorter in the navigation group than in the non-navigation group, both in the whole cohort (15.3 24.8 min, P=0.011) and in the complicated cohort (15.4 27.5 min, P=0.004), while there was no significant difference in the regular cohort. The overall operative time and estimated blood loss in the navigation group tended to be less, although the difference was not statistically significant. No difference in anastomosis time, postoperative hospital stay or complications was noted between the two groups in either cohort. At a mean follow-up of 11.2 months, the overall success rate was 94.7% (36/38), and there was no significant difference between the two groups.
Real-time navigation by 3D virtual reconstruction models might be helpful to improve surgical efficiency and safety of RALP by facilitating the dissection around the UPJ, especially for cases of complicated UPJO. However, the prospective study with larger sample size is further needed to confirm the results.
本研究旨在评估三维（3D）虚拟重建模型在机器人辅助腹腔镜肾盂成形术（RALP）中实时手术导航的有效性和安全性。
回顾性纳入2018年11月至2020年1月期间接受RALP的38例输尿管肾盂连接部梗阻（UPJO）患者。16例患者术中采用3D模型实时辅助，22例患者未进行导航手术。根据患者是否有既往干预史、是否存在交叉血管或先天性畸形，进一步将患者分为“复杂性UPJO”队列和“普通UPJO”队列进行亚组分析。记录并比较两组患者的人口统计学特征、术中参数、围手术期数据和随访数据。
所有手术均成功完成，无需中转开放手术或腹腔镜手术。导航组至UPJ的平均游离时间在整个队列（15.3±24.8分钟，P = 0.011）和复杂性队列（15.4±27.5分钟，P = 0.004）中均短于非导航组，而在普通队列中无显著差异。导航组的总手术时间和估计失血量虽有减少趋势，但差异无统计学意义。两组在吻合时间、术后住院时间或并发症方面均无差异。平均随访11.2个月时，总体成功率为94.7%（36/38），两组间无显著差异。
3D虚拟重建模型实时导航可能有助于通过促进UPJ周围的游离来提高RALP的手术效率和安全性，尤其是对于复杂性UPJO病例。然而，还需要更大样本量的前瞻性研究来证实结果。
