Departments of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.
Int Braz J Urol. 2023 May-Jun;49(3):372-382. doi: 10.1590/S1677-5538.IBJU.2022.0623.
To evaluate the role of three-dimensional (3D) reconstruction in preoperative planning for complex renal tumors.
A well-planned questionnaire was distributed among the attending urologists at an international meeting. The questionnaire inquired about demographic data, surgical experience, partial nephrectomy (PN) versus radical nephrectomy (RN), surgical approach, time of ischemia, probability of postoperative urine leakage and positive surgical margins after viewing computed tomography (CT) scans and their respective 3D models of six complex renal tumors. Following the CT scans, attendees were asked to view randomly selected reconstructions of the cases.
One hundred expert urologists participated in the study; 61% were aged between 40 and 60 years. Most of them (74%) were consultants. The overall likelihood of PN after viewing the 3D reconstructions significantly increased (7.1±2.7 vs. 8.0±2.2, p<0.001), the probability of conversion to RN significantly decreased (4.3±2.8 vs. 3.2±2.5, p<0.001), and the likelihood of urine leakage and positive surgical margins significantly decreased (p<0.001). Preference for the open approach significantly decreased (21.2% vs. 12.1%, p<0.001), while selective clamping techniques significantly increased (p<0.001). After viewing the 3D models, low expected warm ischemia time and estimated blood loss were significantly preferred by the respondents (p<0.001). Surgical decision change was significantly associated with performance or participation in more than 20 PNs or RNs annually [3.25 (1.98-5.22) and 2.87 (1.43-3.87), respectively].
3D reconstruction models play a significant role in modifying surgeons' strategy and surgical planning for patients with renal tumors, especially for patients with stronger indications for a minimally invasive and/or nephron-sparing approach.
评估三维（3D）重建在复杂肾肿瘤术前规划中的作用。
在一次国际会议上，向与会泌尿科医师精心设计了一份问卷调查。问卷内容包括人口统计学数据、手术经验、部分肾切除术（PN）与根治性肾切除术（RN）、手术入路、缺血时间、术后尿漏和阳性手术切缘的可能性，以及在观看 CT 扫描及其各自的 6 个复杂肾肿瘤 3D 模型后。在观看 CT 扫描后，要求与会者随机选择病例进行重建。
共有 100 名泌尿科专家参与了这项研究，其中 61%的年龄在 40 至 60 岁之间。他们中的大多数（74%）是顾问。观看 3D 重建后，PN 的总体可能性显著增加（7.1±2.7 比 8.0±2.2，p<0.001），转为 RN 的可能性显著降低（4.3±2.8 比 3.2±2.5，p<0.001），尿漏和阳性手术切缘的可能性显著降低（p<0.001）。开放入路的偏好明显降低（21.2%比 12.1%，p<0.001），而选择性夹闭技术明显增加（p<0.001）。观看 3D 模型后，受访者明显更倾向于低预期热缺血时间和估计失血量（p<0.001）。手术决策的改变与每年进行 20 例以上 PN 或 RN 手术的表现或参与显著相关[3.25（1.98-5.22）和 2.87（1.43-3.87）]。
3D 重建模型在改变外科医师对肾肿瘤患者的策略和手术规划方面发挥了重要作用，特别是对那些具有更强的微创和/或保留肾单位手术适应证的患者。
