Yamazaki Masahiro, Takayama Tatsuya, Fujita Akifumi, Kikuchi Tomohiro, Kamimura Tomoki, Myoga Hiroaki, Mayumi Shozaburo, Yazaki Kai, Katano Saki, Komatsubara Maiko, Kamei Jun, Sugihara Toru, Ando Satoshi, Fujimura Tetsuya
Department of Urology, Jichi Medical University, Shimotuke City, Japan.
Department of Urology, International University of Health and Welfare Hospital, Nasushiobara-shi, Japan.
Asian J Endosc Surg. 2023 Apr;16(2):197-202. doi: 10.1111/ases.13136. Epub 2022 Oct 18.
This study aimed to evaluate whether it is useful for junior physicians to use a three-dimensional (3D) kidney model when evaluating the R.E.N.A.L. nephrometry score.
An expert and four urology residents retrospectively evaluated the R.E.N.A.L. nephrometry scores of 64 renal tumors (62 patients) that underwent robot-assisted partial nephrectomy at our hospital. The expert evaluated 64 R.E.N.A.L. nephrometry scores with computed tomography (CT), whereas four residents evaluated 32 cases using CT alone and the other 32 cases using CT and a 3D kidney model. The consistency between the expert and residents was assessed by Cohen's kappa score. Patient-specific 3D kidney models were created in a gird style using a 3D printer based on CT or magnetic resonance imaging of the patient.
For all four residents, the accuracy of the overall R.E.N.A.L. nephrometry score was significantly higher with the 3D model and CT than with CT alone (P < .001). Regarding the individual components of the R.E.N.A.L. nephrometry score, the accuracy rates of "E," "N," "A," and "L" scores were higher with the 3D model and CT than with the CT alone (P = .020-.089).
Patient-specific 3D-printed kidney models could improve the resident's understanding of the renal tumor complexity and could be an important educational tool for residents.
本研究旨在评估初级医师在评估R.E.N.A.L.肾计量评分时使用三维（3D）肾脏模型是否有用。
一名专家和四名泌尿外科住院医师回顾性评估了我院64例接受机器人辅助部分肾切除术的肾肿瘤（62例患者）的R.E.N.A.L.肾计量评分。专家使用计算机断层扫描（CT）评估64个R.E.N.A.L.肾计量评分，而四名住院医师分别单独使用CT评估32例，使用CT和3D肾脏模型评估另外32例。通过科恩kappa评分评估专家与住院医师之间的一致性。基于患者的CT或磁共振成像，使用3D打印机以网格样式创建患者特异性3D肾脏模型。
对于所有四名住院医师，使用3D模型和CT时，R.E.N.A.L.肾计量评分的总体准确性显著高于单独使用CT（P < 0.001）。关于R.E.N.A.L.肾计量评分的各个组成部分，使用3D模型和CT时，“E”“N”“A”和“L”评分的准确率高于单独使用CT（P = 0.020 - 0.089）。
患者特异性3D打印肾脏模型可提高住院医师对肾肿瘤复杂性的理解，并且可能成为住院医师的重要教育工具。
