3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes

Abstract

Objectiveto evaluate the impact of 3D model for a comprehensive assessment of surgical planning and quality of partial nephrectomy (PN).Materials and methods195 patients with cT1-T2 renal mass scheduled for PN were enrolled in two groups: Study Group (n= 100), including patients referred to PN with revision of both 2D computed tomography (CT) imaging and 3D model; Control group (n= 95), including patients referred to PN with revision of 2D CT imaging. Overall, 20 individuals were switched to radical nephrectomy (RN). The primary outcome was the impact of 3D models-based surgical planning on Trifecta achievement (defined as the contemporary absence of positive surgical margin, major complications and ≤30% postoperative eGFR reduction). The secondary outcome was the impact of 3D models on surgical planning of PN. Multivariate logistic regressions were used to identify predictors of selective clamping and Trifecta’s achievement in patients treated with PN (n=175).ResultsOverall, 73 (80.2%) patients in Study group and 53 (63.1%) patients in Control group achieved the Trifecta (p=0.01). The preoperative plan of arterial clamping was recorded as clampless, main artery and selective in 22 (24.2%), 22 (24.2%) and 47 (51.6%) cases in Study group vs. 31 (36.9%), 46 (54.8%) and 7 (8.3%) cases in Control group, respectively (p<0.001). At multivariate logistic regressions, the use of 3D model was found to be independent predictor of both selective or super-selective clamping and Trifecta’s achievement.Conclusion3D-guided approach to PN increase the adoption of selective clamping and better predict the achievement of Trifecta.

Application of three-dimensional reconstruction in partial nephrectomy, a systematic review and meta‑analysis

“…After duplicated records excluded, 67 studies left then we Screened the titles, abstracts and topics. The full-texts were evaluated by the excluding criteria, a nal 17 studies [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] embracing 714 cases and 801 controls were included for extracting data. The literature search and selection process as the ow chart is shown in Fig.…”

“…There were 15 studies 15,[17][18][19][20][21][22][23][24][26][27][28][29][30][31] have showed the results of estimated blood loss in 3D (n=669) and non-3D group (n=756). The heterogeneity among studies is high (I2 >50%), then a random effect model was used.…”

“…The results of length of hospital stay including in 8 studies 17,18,23,[26][27][28][29][30] . The nal meta-analysis showed there was no signi cant difference of hospital stay length between 3D (n=441) and non-3D group (n=496) (SMD -0.03, 95% CI -0.82 to 0.77; p < 0.001).…”

“…We extracted data on positive surgical margins from 8 studies 17,19,22,[25][26][29][30][31] (n(3D)=416,n(non-3D)=488) and intraoperative complications from 10 studies(17-18,22,24-26,28-31) (n(3D)=478,n(non-3D)=545). Fixed effect models were used based on the heterogeneity test.…”

“…There were 8 studies 15,[17][18]20,22,24,28,30 have showed the results of declining of eGFR in 3D (n=366) and non-3D group (n=433). The eGFR declining in patients undergoing PN with 3D or without 3D assisted was showed no signi cant difference (SMD -0.05, 95% CI -0.34 to 0.23; p < 0.001) (Fig.…”