Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
Int J Urol. 2023 Dec;30(12):1087-1095. doi: 10.1111/iju.15287. Epub 2023 Aug 25.
Partial nephrectomy (PN) is the standard treatment for T1 renal cell carcinoma. PN is affected more by surgical variations and requires greater surgical experience than radical nephrectomy. Patient-specific simulations and navigation systems may help to reduce the surgical experience required for PN. Recent advances in three-dimensional (3D) virtual reality (VR) imaging and 3D printing technology have allowed accurate patient-specific simulations and navigation systems. We reviewed previous studies about patient-specific simulations and navigation systems for PN. Recently, image reconstruction technology has developed, and commercial software that converts two-dimensional images into 3D images has become available. Many urologists are now able to view 3DVR images when preparing for PN. Surgical simulations based on 3DVR images can change surgical plans and improve surgical outcomes, and are useful during patient consultations. Patient-specific simulators that are capable of simulating surgical procedures, the gold-standard form of patient-specific simulations, have also been reported. Besides VR, 3D printing is also useful for understanding patient-specific information. Some studies have reported simulation and navigation systems for PN based on solid 3D models. Patient-specific simulations are a form of preoperative preparation, whereas patient-specific navigation is used intraoperatively. Navigation-assisted PN procedures using 3DVR images have become increasingly common, especially in robotic surgery. Some studies found that these systems produced improvements in surgical outcomes. Once its accuracy has been confirmed, it is hoped that this technology will spread further and become more generalized.
肾部分切除术（PN）是 T1 期肾细胞癌的标准治疗方法。与根治性肾切除术相比，PN 受手术变异的影响更大，需要更多的手术经验。针对患者的模拟和导航系统可能有助于减少 PN 所需的手术经验。近年来，三维（3D）虚拟现实（VR）成像和 3D 打印技术的进步使得精确的针对患者的模拟和导航系统成为可能。我们回顾了关于 PN 的针对患者的模拟和导航系统的以往研究。最近，图像重建技术已经发展起来，并且可以使用将二维图像转换为 3D 图像的商业软件。现在，许多泌尿科医生在准备 PN 时都可以查看 3DVR 图像。基于 3DVR 图像的手术模拟可以改变手术计划并改善手术结果，并且在患者咨询时非常有用。也有报道称，已经开发出能够模拟手术过程的针对患者的模拟器，这是针对患者的模拟的金标准形式。除了 VR 之外，3D 打印对于理解针对患者的信息也很有用。一些研究已经报道了基于实体 3D 模型的 PN 模拟和导航系统。针对患者的模拟是术前准备的一种形式，而针对患者的导航则用于手术过程中。使用 3DVR 图像进行的导航辅助 PN 手术已经越来越普遍，尤其是在机器人手术中。一些研究发现这些系统改善了手术结果。一旦其准确性得到确认，希望这项技术将得到更广泛的传播和应用。
