Feasibility and accuracy of computational robot‐assisted partial nephrectomy planning by virtual partial nephrectomy analysis

Abstract

Abbreviations & Acronyms Cr = creatinine CT = computed tomography eGFR = estimated glomerular filtration rate MDCT = Multidetector computed tomography PADUA = Preoperative Aspects and Dimensions Used for an Anatomical PN = partial nephrectomy RAPN = robot-assisted partial nephrectomy RCV = renal cortical volume RENAL = Radius, Exophytic/endophytic properties, Nearness of the tumor to the collecting system or sinus, Anterior/posterior, Location relative to the polar lines RPV = renal parenchymal volume RV = resection volume VPNA = virtual partial nephrectomy analysis Objectives: To evaluate the feasibility and accuracy of virtual partial nephrectomy analysis, including a color-coded three-dimensional virtual surgical planning and a quantitative functional analysis, in predicting the surgical outcomes of robot-assisted partial nephrectomy. Methods: Between 2012 and 2014, 20 patients underwent virtual partial nephrectomy analysis before undergoing robot-assisted partial nephrectomy. Virtual partial nephrectomy analysis was carried out with the following steps: (i) evaluation of the arterial branch for selective clamping by showing the vascular-supplied area; (ii) simulation of the optimal surgical margin in precise segmented three-dimensional model for prediction of collecting system opening; and (iii) detailed volumetric analyses and estimates of postoperative renal function based on volumetric change. At operation, the surgeon identified the targeted artery and determined the surgical margin according to the virtual partial nephrectomy analysis. The surgical outcomes between the virtual partial nephrectomy analysis and the actual robotassisted partial nephrectomy were compared. Results: All 20 patients had negative cancer surgical margins and no urological complications. The tumor-specific renal arterial supply areas were shown in color-coded threedimensional model visualization in all cases. The prediction value of collecting system opening was 85.7% for sensitivity and 100% for specificity. The predicted renal resection volume was significantly correlated with actual resected specimen volume (r 2 = 0.745, P < 0.001). The predicted estimated glomerular filtration rate was significantly correlated with actual postoperative estimated glomerular filtration rate (r 2 = 0.736, P < 0.001). Conclusions: Virtual partial nephrectomy analysis is able to provide the identification of tumor-specific renal arterial supply, prediction of collecting system opening and prediction of postoperative renal function. This technique might allow urologists to compare various arterial clamping methods and resection margins with surgical outcomes in a non-invasive manner.Key words: robot-assisted partial nephrectomy, simulation, three-dimensional anatomical model, virtual operation, volumetry. IntroductionCurrently, the treatment for stage I renal tumors is nephron-sparing surgery, which is the standard of care for T1a and most T1b tumors, and the role of RAPN in the nephron-sparing surgery armamentarium is expanding. [1][2][3][4] In 20...

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Peking University - Juntendo University Joint Symposium on Cancer Research and Treatment

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