Ianiotescu Stelian, Gingu Constantin, Sanda Nicoleta, Iordache Alexandru, Dick Alexandru, Sinescu Ioanel
Urology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Center of Uronephrology and Kidney Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania.
Healthcare (Basel). 2025 Sep 17;13(18):2325. doi: 10.3390/healthcare13182325.
Intraoperative ultrasound (IOUS) is increasingly utilized in nephron-sparing surgery for its ability to provide real-time, high-resolution imaging that enhances tumor localization and resection accuracy. Its role becomes particularly important in anatomically complex cases such as endophytic, multifocal, or recurrent renal tumors, as well as in patients with a solitary kidney. We conducted a retrospective analysis of 152 patients who underwent partial nephrectomy for localized renal tumors between January 2019 and December 2024. Patients were divided into two groups: Group A (n = 24) included patients with a solitary surgical kidney or tumor recurrence; Group B (n = 128) included patients with a contralateral functional kidney. IOUS was used in 31 cases (20%). Demographic, perioperative, and oncological outcomes were compared, with specific attention to the use and impact of IOUS. IOUS was significantly more common in Group A (75%) than in Group B (10%) ( < 0.001), reflecting its preferential use in higher-complexity surgeries. The rate of positive surgical margins was low overall, with no significant difference between the IOUS and non-IOUS groups (3.2% vs. 1.7%; = 0.54). IOUS was more frequently employed in cases involving medium/high RENAL nephrometry scores and multifocal tumors, contributing to improved intraoperative tumor delineation without increasing complication rates. IOUS enhances surgical precision and supports oncologic safety in both robotic and open partial nephrectomies, particularly in complex scenarios. Its use should be encouraged as a standard adjunct in conservative renal surgery, especially in patients with a solitary kidney, recurrent disease, or multifocal tumors.
术中超声（IOUS）因其能够提供实时、高分辨率成像，从而提高肿瘤定位和切除准确性，在保留肾单位手术中得到越来越广泛的应用。在解剖结构复杂的病例中，如内生性、多灶性或复发性肾肿瘤，以及单肾患者中，其作用尤为重要。我们对2019年1月至2024年12月期间因局限性肾肿瘤接受部分肾切除术的152例患者进行了回顾性分析。患者分为两组：A组（n = 24）包括单肾手术或肿瘤复发的患者；B组（n = 128）包括对侧肾功能正常的患者。31例（20%）患者使用了IOUS。比较了人口统计学、围手术期和肿瘤学结局，特别关注IOUS的使用及其影响。IOUS在A组（75%）中显著比B组（10%）更常见（<0.001），这反映了其在更高复杂性手术中的优先使用。总体手术切缘阳性率较低，IOUS组和非IOUS组之间无显著差异（3.2%对1.7%；P = 0.54）。IOUS在涉及中/高RENAL肾计量评分和多灶性肿瘤的病例中更频繁使用，有助于改善术中肿瘤轮廓的描绘，而不增加并发症发生率。IOUS在机器人辅助和开放性部分肾切除术中均提高了手术精度并支持肿瘤学安全性，特别是在复杂情况下。应鼓励将其作为保守性肾手术的标准辅助手段，尤其是在单肾、复发性疾病或多灶性肿瘤患者中。
