Amparore Daniele, Piramide Federico, Pecoraro Angela, Verri Paolo, Checcucci Enrico, De Cillis Sabrina, Piana Alberto, Busacca Giovanni, Manfredi Matteo, Fiori Cristian, Porpiglia Francesco
Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands.
Eur Urol Open Sci. 2022 Mar 4;38:60-66. doi: 10.1016/j.euros.2022.02.006. eCollection 2022 Apr.
Some renal tumors have an imperative indication for nephron-sparing surgery (NSS), such as in cases of chronic kidney disease and bilateral complex tumors.
To demonstrate the degree to which three-dimensional virtual model (3DVM) assistance can be helpful in planning the surgical strategy for high-complexity renal masses with an imperative indication for NSS.
Three patients with high-complexity renal masses with unusual anatomy and an imperative indication for NSS were prospectively selected across 2020 and 2021 at our institution. All patients underwent contrast-enhanced computed tomography from which a 3DVM was obtained.
Robot-assisted partial nephrectomy with 3DVM augmented reality guidance.
Demographics and tumor-related features were recorded. Data for intraoperative, pathological, and functional assessments were collected for all three patients.
Two of the three patients harbored bilateral renal tumors. The third patient presented with a renal mass in the left kidney and contralateral renal hypoplasia (right-split renal function of 25%). All of the patients demonstrated similar anatomical and tumor features on 3DVMs, with potentially independent vascularization and drainage for the lower pole. In one patient the upper pole of the kidney was spared, exiting in a functionally excluded hydrocalyx, while in the other two cases the upper pole was removed together with the lesion. The spared portion of the kidney retained vascularization, as demonstrated by intraoperative ultrasound and indocyanine green injection. The small sample size and short follow-up are the main limitations of the study.
3DVMs, especially for complex renal masses with an imperative indication for NSS, allow planning of the surgical strategy on the basis of the anatomical characteristics of the organ in which the tumor is growing.
Three-dimensional models help in defining the best surgical strategy for kidney tumors, especially for complex tumors that require surgery to spare as much of the kidney as possible.
一些肾肿瘤有进行保留肾单位手术（NSS）的迫切指征，如慢性肾脏病和双侧复杂性肿瘤病例。
证明三维虚拟模型（3DVM）辅助在为有NSS迫切指征的高复杂性肾肿块制定手术策略时的帮助程度。
设计、场所和参与者：2020年至2021年在我们机构前瞻性选择了3例有不寻常解剖结构且有NSS迫切指征的高复杂性肾肿块患者。所有患者均接受了对比增强计算机断层扫描，并据此获得了3DVM。
在3DVM增强现实引导下进行机器人辅助部分肾切除术。
记录人口统计学和肿瘤相关特征。收集了所有3例患者的术中、病理和功能评估数据。
3例患者中有2例患有双侧肾肿瘤。第3例患者左肾有一个肾肿块，对侧肾发育不全（右侧分肾功能为25%）。所有患者在3DVM上均表现出相似的解剖和肿瘤特征，下极可能有独立的血管供应和引流。1例患者的肾上极得以保留，位于功能上排除的肾盂积水处，而在另外2例中，肾上极与病变一起被切除。术中超声和吲哚菁绿注射显示，保留的肾部分保持了血管供应。本研究的主要局限性是样本量小和随访时间短。
3DVM，特别是对于有NSS迫切指征的复杂肾肿块，能够根据肿瘤生长器官的解剖特征来制定手术策略。
三维模型有助于确定肾肿瘤的最佳手术策略，特别是对于需要手术以尽可能保留肾脏的复杂肿瘤。
