Department of Urology and All India Institute of Medical Sciences, New Delhi, India.
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
J Endourol. 2021 Sep;35(9):1405-1410. doi: 10.1089/end.2020.1103. Epub 2021 Aug 16.
To qualitatively assess the clinical usefulness of patient-specific high-fidelity three-dimensional (3D) print model of kidney before partial nephrectomy (PN) and to identify subset domains where it may help in clinical terms. Thirteen 3D models were printed for tumors having RENAL nephrometry score of ≥8. Their usage for PN was assessed prospectively using a qualitative questionnaire to be answered on a Likert scale of 1-10. The questions focused on realistic resemblance, preoperative dry surgical run, intertest comparison, surgical impact, and overall beneficence domains as perceived by primary surgeons with respect to surgical conduct during PN. Mean RENAL score was 9.15 (8-11). Models were rated high (9.07 ± 0.86) for realistic resemblance domain and were rated better than contrast-enhanced computed tomography (CECT) (8.38 ± 0.87) and intraoperative ultrasonography (8.07 ± 1.26) for orientation regarding resection margins. A further marginal improvement to 8.2 ± 0.84 was noted against ultrasound where surgeon did a dry cut preoperatively. Use of superselective arterial approach in four, precise awareness about dissection of a major vessel in four, retroperitoneoscopic approach in one, and surgical margin awareness in three were directly attributed to the model. Overall utility of having a model printed was rated high (8.23 ± 1.3). The 3D print models of complex renal tumors have high realistic resemblance to actual patient's anatomy. They were rated better than preoperative CECT or intraoperative ultrasonography for orientation regarding surgical resection margins. It may also help change or modify the surgical plan in a subset of patients with a potential to improve overall outcomes in these complex cases.
为定性评估肾部分切除术（PN）前患者特异性高保真三维（3D）打印模型的临床实用性，并确定其在临床上可能有帮助的亚域。为 RENAL 肾肿瘤评分≥8 的肿瘤打印了 13 个 3D 模型。使用定性问卷前瞻性评估其在 PN 中的使用情况，使用 1-10 的李克特量表回答问题。问题集中在主要外科医生对 PN 期间手术进行的现实相似性、术前干燥手术运行、测试间比较、手术影响和整体受益等方面。平均 RENAL 评分为 9.15（8-11）。模型在现实相似性域中被评为高分（9.07±0.86），并在定向切除边缘方面被评为优于对比增强计算机断层扫描（CECT）（8.38±0.87）和术中超声（8.07±1.26）。在超声检查中，医生术前进行干燥切割时，评分进一步提高到 8.2±0.84。在 4 例中使用超选择性动脉入路，在 4 例中精确了解主要血管的解剖，在 1 例中使用后腹腔镜入路，在 3 例中了解手术边缘，这些都直接归因于模型。打印模型的整体实用性被评为高分（8.23±1.3）。复杂肾肿瘤的 3D 打印模型与实际患者的解剖结构具有高度的现实相似性。它们在定向手术切除边缘方面优于术前 CECT 或术中超声。它还可能帮助改变或修改部分患者的手术计划，有可能改善这些复杂病例的总体结果。
