Gershman Boris, Psutka Sarah P, Matsumoto Jane M, King Bernard F, Kawashima Akira, Morris Jonathan M, Leibovich Bradley C
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Urol Pract. 2016 Mar;3(2):124-133. doi: 10.1016/j.urpr.2015.05.008. Epub 2015 Dec 21.
Nephron sparing surgery may be challenging in cases of complex or aberrant renal anatomy. 3-Dimensional printing technology has allowed the creation of 3-dimensional models that can aid in preoperative surgical planning and simulation. We describe the construction of personalized 3-dimensional kidney models, and present a series of patients with complex surgical anatomy to illustrate their use in surgical planning and performance of complex nephron sparing surgery.
Three patients with complex renal masses were identified. Contrast enhanced computerized tomography studies were used to create segmentation images based on separate scan phases, which were overlaid to create virtual 3-dimensional models. High-fidelity 3-dimensional physical models were then created using 3-dimensional printing technology. The 3-dimensional models were used as an aid in the surgical planning and performance of nephron sparing surgery.
Three patients with complex renal anatomy presented with T1b or T2 renal masses. Two patients had absolute or relative indications for nephron sparing surgery and in 1 patient a benign mass was suspected on imaging. The 3-dimensional kidney models were constructed based on preoperative cross-sectional imaging to evaluate the feasibility of nephron sparing surgery and to simulate the surgical approach. All patients underwent successful nephron sparing surgery with negative surgical margins and preservation of renal function at followup.
We describe the creation of personalized 3-dimensional kidney models to facilitate the visualization of the renal mass and its relationship with surrounding structures, the identification of renal and tumor vasculature, and the evaluation of aberrant anatomy. These 3-dimensional models represent a valuable tool for preoperative planning and simulation in cases with complex anatomical considerations.
在复杂或异常肾脏解剖结构的病例中，保留肾单位手术可能具有挑战性。三维打印技术已使三维模型的创建成为可能，这些模型有助于术前手术规划和模拟。我们描述了个性化三维肾脏模型的构建，并展示了一系列具有复杂手术解剖结构的患者，以说明其在保留肾单位复杂手术的手术规划和实施中的应用。
确定了三名患有复杂肾肿块的患者。使用对比增强计算机断层扫描研究，根据不同的扫描阶段创建分割图像，将这些图像叠加以创建虚拟三维模型。然后使用三维打印技术创建高保真三维实体模型。这些三维模型被用作保留肾单位手术的手术规划和实施的辅助工具。
三名具有复杂肾脏解剖结构的患者表现为T1b或T2期肾肿块。两名患者有保留肾单位手术的绝对或相对指征，一名患者在影像学上怀疑为良性肿块。基于术前横断面成像构建三维肾脏模型，以评估保留肾单位手术的可行性并模拟手术入路。所有患者均成功接受了保留肾单位手术，手术切缘阴性，随访时肾功能得以保留。
我们描述了个性化三维肾脏模型的创建，以促进肾肿块及其与周围结构关系的可视化、肾和肿瘤血管系统的识别以及异常解剖结构的评估。这些三维模型是术前规划和模拟复杂解剖学考虑病例的宝贵工具。
