Piramide Federico, Kowalewski Karl-Friedrich, Cacciamani Giovanni, Rivero Belenchon Ines, Taratkin Mark, Carbonara Umberto, Marchioni Michele, De Groote Ruben, Knipper Sophie, Pecoraro Angela, Turri Filippo, Dell'Oglio Paolo, Puliatti Stefano, Amparore Daniele, Volpi Gabriele, Campi Riccardo, Larcher Alessandro, Mottrie Alex, Breda Alberto, Minervini Andrea, Ghazi Ahmed, Dasgupta Prokar, Gozen Ali, Autorino Riccardo, Fiori Cristian, Di Dio Michele, Gomez Rivas Juan, Porpiglia Francesco, Checcucci Enrico
Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy; European Association of Urology Young Academic Urologists Robotic Surgery Working Group, Arnhem, The Netherlands.
Department of Urology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands.
Eur Urol Oncol. 2022 Dec;5(6):640-650. doi: 10.1016/j.euo.2022.09.003. Epub 2022 Oct 7.
Use of three-dimensional (3D) guidance for nephron-sparing surgery (NSS) has increased in popularity, especially for laparoscopic and robotic approaches. Different 3D visualization modalities have been developed as promising new tools for surgical planning and intraoperative navigation.
To summarize and evaluate the impact of 3D models on minimally invasive NSS in terms of perioperative, functional, and oncological outcomes.
A systematic literature search was conducted in December 2021 using the Medline (PubMed), Embase (Ovid), Scopus, and Web of Science databases. The protocol was registered on PROSPERO (CRD42022300948). The search strategy used the PICOS (Population, Intervention, Comparison, Outcome, Study design) criteria and article selection was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Meta-analysis was performed using the Mantel-Haenszel method for binary outcomes, with results summarized as the odds ratio (OR), and the inverse variance method for continuous data, with results reported as the mean difference (MD). All effect estimates are reported with the 95% confidence interval (CI) and p ≤ 0.05 was considered statistically significant. All analyses were performed using R software and the meta package.
The initial electronic search identified 450 papers, of which 17 met the inclusion criteria and were included in the analysis. Use of 3D technology led to a significant reduction in the global ischemia rate (OR 0.22, 95% CI 0.07-0.76; p = 0.02) and facilitated more frequent enucleation (OR 2.54, 95% CI 1.36-4.74; p < 0.01) and less frequent opening of the collecting system (OR 0.36, 95% CI 0.15-0.89; p = 0.03) and was associated with less blood loss (MD 23.1 ml, 95% CI 31.8-14.4; p < 0.01). 3D guidance for NSS was associated with a significant reduction in the transfusion rate (OR 0.20, 95% CI 0.07-0.56; p < 0.01). There were no significant differences in rates of conversion to radical nephrectomy, minor and major complications, change in glomerular filtration rate, or surgical margins (all p > 0.05).
3D guidance for NSS is associated with lower rates of detriment and surgical injury to the kidney. Specifically, a lower amount of nontumor renal parenchyma is exposed to ischemia or sacrificed during resection, and opening of the collecting system is less frequent. However, use of 3D technology does not lead to significant improvements in oncological or functional outcomes.
We reviewed the use of three-dimensional tools for minimally invasive surgery for partial removal of the kidney in patients with kidney cancer. The evidence suggests that these tools have benefits during surgery, but do not lead to significant improvements in cancer control or functional outcomes for patients.
三维（3D）引导在保留肾单位手术（NSS）中的应用越来越普遍，尤其是在腹腔镜和机器人手术中。不同的3D可视化模式已被开发为手术规划和术中导航的有前景的新工具。
总结并评估3D模型对微创NSS围手术期、功能和肿瘤学结局的影响。
2021年12月使用Medline（PubMed）、Embase（Ovid）、Scopus和Web of Science数据库进行了系统的文献检索。该方案已在PROSPERO（CRD42022300948）上注册。检索策略采用PICOS（人群、干预措施、对照、结局、研究设计）标准，并根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行文章选择。评估了纳入文章的偏倚风险和质量。使用专门的数据提取表收集感兴趣的数据。对于二元结局，采用Mantel-Haenszel方法进行Meta分析，结果汇总为比值比（OR）；对于连续数据，采用逆方差法，结果报告为平均差（MD）。所有效应估计值均报告95%置信区间（CI），p≤0.05被认为具有统计学意义。所有分析均使用R软件和meta包进行。
初步电子检索确定了450篇论文，其中17篇符合纳入标准并纳入分析。使用3D技术导致总体缺血率显著降低（OR 0.22，95%CI 0.07-0.76；p = 0.02），并促进更频繁的剜除术（OR 2.54，95%CI 1.36-4.74；p < 0.01）和更少频繁的集合系统开放（OR 0.36，95%CI 0.15-0.89；p = 0.03），且与更少的失血相关（MD 23.1 ml，95%CI 31.8-14.4；p < 0.01）。NSS的3D引导与输血率显著降低相关（OR 0.20，95%CI 0.07-0.56；p < 0.01）。在根治性肾切除术的转化率、轻微和严重并发症、肾小球滤过率变化或手术切缘方面无显著差异（所有p > 0.05）。
NSS的3D引导与较低的肾脏损害率和手术损伤相关。具体而言，在切除过程中，较少的非肿瘤性肾实质暴露于缺血或被牺牲，集合系统开放的频率较低。然而，使用3D技术并未导致肿瘤学或功能结局的显著改善。
我们回顾了三维工具在肾癌患者肾脏部分切除微创手术中的应用。证据表明，这些工具在手术期间有好处，但不会导致患者的癌症控制或功能结局有显著改善。
