Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA.
Surgical Learning and Innovation Center of Excellence , Johns Hopkins University, Baltimore, MD, USA.
World J Urol. 2024 Oct 29;42(1):602. doi: 10.1007/s00345-024-05301-w.
With the advancement of surgical technology, the opportunity to integrate novel surgical preparation is imperative to improve patient outcomes and enhance safety.
Patient specific perfused kidney phantoms including the tumor, parenchyma, artery, vein, and calyx were fabricated using 3D-printing and hydrogel injection molding from scans of 25 patients scheduled for robotic partial-nephrectomy (RAPN). Models are validated for anatomical accuracy, mechanical, functional properties and surrounded by the other models of relevant anatomy in a body cast for a simulated surgical rehearsal. We investigated the impact of these preoperative rehearsals preceding complex RAPN by analyzing changes in surgeons' decisions following review of both axial-imaging and following rehearsal simulation. Predictive ability of these rehearsal platforms was compared to live surgery outcomes and trifecta of cases as an outcome was calculated.
25 patients with complex renal tumors, average 9.8 nephrometry score and 4.9 cm mean tumor diameter were consented. Mean blood loss and WIT were 193.2 ml and 19.8 min. Two Clavien 2 complications were reported at 30-day postoperative. Trifecta was achieved in 17 (68%) of surgical cases. Surgeons' confidence in their ability to complete a partial nephrectomy and ability to predict WIT significantly increased from initial viewing the axial imaging to after the rehearsal. The correlation coefficient between the procedural clinical data collected during the rehearsals and live surgery were calculated.
The application of this versatile method for creating authentic perfused kidney phantoms can result in increased confidence in surgical plan and thus improved surgical performance and outcomes.
随着外科技术的进步，整合新的外科准备机会对于改善患者的预后和提高安全性至关重要。
使用 3D 打印和水凝胶注塑技术，从 25 例计划接受机器人部分肾切除术（RAPN）的患者的扫描中，制造了包括肿瘤、实质、动脉、静脉和肾盂的患者特异性灌注肾模型。对模型进行了解剖准确性、机械和功能特性的验证，并在体模中围绕相关解剖结构的其他模型进行了模拟手术排练。我们通过分析轴向成像和模拟排练后审查前后外科医生决策的变化，研究了这些术前排练对复杂 RAPN 的影响。比较了这些排练平台的预测能力与实际手术结果，并计算了 trifecta 病例作为结果。
25 例复杂肾肿瘤患者，平均肾肿瘤评分 9.8 分，肿瘤平均直径 4.9 厘米。平均失血量和 WIT 分别为 193.2ml 和 19.8 分钟。术后 30 天报告了 2 例 Clavien 2 级并发症。17 例（68%）手术病例达到 trifecta。外科医生完成部分肾切除术的能力和预测 WIT 的能力从最初观看轴向成像到排练后显著提高。对排练过程中收集的程序临床数据与实际手术之间的相关性系数进行了计算。
这种通用方法用于创建真实灌注肾模型，可以提高手术计划的信心，从而提高手术效果和结果。
