Deep Learning Plus Three-Dimensional Printing in the Management of Giant (>15 cm) Sporadic Renal Angiomyolipoma: An Initial Report

Abstract

ObjectiveTo evaluate the feasibility and effectivity of deep learning (DL) plus three-dimensional (3D) printing in the management of giant sporadic renal angiomyolipoma (RAML).MethodsThe medical records of patients with giant (>15 cm) RAML were retrospectively reviewed from January 2011 to December 2020. 3D visualized and printed kidney models were performed by DL algorithms and 3D printing technology, respectively. Patient demographics and intra- and postoperative outcomes were compared between those with 3D-assisted surgery (3D group) or routine ones (control group).ResultsAmong 372 sporadic RAML patients, 31 with giant ones were eligible for analysis. The median age was 40.6 (18–70) years old, and the median tumor size was 18.2 (15–28) cm. Seventeen of 31 (54.8%) had a surgical kidney removal. Overall, 11 underwent 3D-assisted surgeries and 20 underwent routine ones. A significant higher success rate of partial nephrectomy (PN) was noted in the 3D group (72.7% vs. 30.0%). Patients in the 3D group presented a lower reduction in renal function but experienced a longer operation time, a greater estimated blood loss, and a higher postoperative morbidity. Subgroup analysis was conducted between patients undergoing PN with or without 3D assistance. Despite no significant difference, patients with 3D-assisted PN had a slightly larger tumor size and higher nephrectomy score, possibly contributing to a relatively higher rate of complications. However, 3D-assisted PN lead to a shorter warm ischemia time and a lower renal function loss without significant difference. Another subgroup analysis between patients under 3D-assisted PN or 3D-assisted RN showed no statistically significant difference. However, the nearness of tumor to the second branch of renal artery was relatively shorter in 3D-assisted PN subgroup than that in 3D-assisted RN subgroup, and the difference between them was close to significant.Conclusions3D visualized and printed kidney models appear to be additional tools to assist operational management and avoid a high rate of kidney removal for giant sporadic RAMLs.

Artificial Intelligence in Surgical Training for Kidney Cancer: A Systematic Review of the Literature

“…Only one article caused disagreement among the reviewers, where the authors assessed the validity of an AI total that may guide the decision to either perform partial or radical nephrectomy (after discussion among the reviewers, it was excluded as this tool has no effect on the surgical skills of the novice) [23]. Finally, 14 articles met our inclusion criteria and were included in the current systematic review [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Figure 1 illustrates the PRISMA flow diagram for the search process.…”

“…There is a scarcity of evidence in the literature regarding the application of AI to enhance surgical skills in the urological discipline. This also applies to the field of surgical training for kidney cancer, where AI has predominantly been employed in the realm of surgical simulations and robot-assisted surgery [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Table 1 shows a summary of the included studies concerning the use of AI in the field of renal cancer training.…”

“…On the other hand, DL algorithms were proposed for the 3D reconstruction of renal models in patients with giant angiomyolipomas, which in turn can be printed to help in preoperative planning, patient-specific rehearsal, and intraoperative guidance during even open surgery. This combination of 3D printing and AI has the potential to enhance training and improve surgical outcomes [28]. In comparison with standard techniques, this combination resulted in significantly higher success rates for partial nephrectomy (30% versus 72%) [28].…”

“…This combination of 3D printing and AI has the potential to enhance training and improve surgical outcomes [28]. In comparison with standard techniques, this combination resulted in significantly higher success rates for partial nephrectomy (30% versus 72%) [28].…”

Three-Dimensional Printing Creates New Trends of the Technological Revolution in Urologic Surgery

“…It is suggested that the use of 3D printing in the evaluation of complex renal carcinoma before partial nephrectomy may be beneficial and is worthy of further clinical exploration. In addition to the treatment of renal cancer, Gao et al 50 have also examined the potential of 3D printing in the treatment of giant renal angiomyolipoma. They conducted a study involving 31 patients with giant renal angiomyolipoma (>15 cm).…”