Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy

Hekman, Marlène C.H.; Rijpkema, Mark; Langenhuijsen, Johan F.; Boerman, Otto C.; Oosterwijk, Egbert; Mulders, Peter F.A.

doi:10.1016/j.euf.2017.04.008

Cited by 62 publications

(43 citation statements)

References 66 publications

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“…Another recent study confirmed the feasibility of ex vivo fluorescence imaging using IRDye800CW in six patients undergoing PN in whom one positive SM was correctly identified [19]. An advantage of fluorescence imaging is that imaging before, during and after tumour resection can easily be combined [20].…”

Section: Discussionmentioning

confidence: 58%

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

et al. 2018

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Purpose To evaluate the feasibility of ex vivo 7T MRI to assess surgical margins (SMs) and pseudocapsule (PC) features after partial nephrectomy (PN). Materials and methods In this prospective, IRB-approved study, seven patients undergoing a PN for nine tumours between November 2014 and July 2015 were included for analysis after obtaining informed consent. MRI of the specimen was acquired using a 7T small bore scanner. The imaging protocol consisted of anatomical T1-, T2-and diffusion-weighted imaging. After formalin fixation, specimens were cut for pathology work-up in the same orientation as the MR images were obtained. The entire specimen was processed into H&E slides that were digitally scanned, annotated and correlated with radiological findings for negative SMs, PC presence, PC continuity and extra-PC-extension (EPCE). Sensitivity and specificity of MRI for assessment of these endpoints were calculated. Results The sensitivity and specificity for assessment of the SM were 100% and 75%, respectively. Two falsepositive outcomes were reported, both in case of EPCE and a SM ≤0.5 mm. For the presence of a PC, sensitivity and specificity were 100% and 33%, respectively. Two false-positive scans with anatomical structures mimicking the presence of a PC occurred. If a PC was present, continuity and EPCE were assessed with a sensitivity and specificity of 75% and 100% and 67% and 100%, respectively. Conclusion Ex vivo 7T MRI is a feasible tool for perioperative evaluation of SMs, and if present, PC features after PN. This may facilitate maximal sparing of renal parenchyma without compromising oncological outcomes. Key Points • Ex vivo MRI may contribute to improvement of negative surgical margins during partial nephrectomy.• Due to the assessment of surgical margins within a limited time span from obtaining the partial nephrectomy specimen, surgery for more complex tumours is possible with maximum sparing of healthy renal parenchyma without compromising oncological outcomes.• The intra operative assessment of pseudocapsule continuity along the resection margin enables maximal sparing of healthy renal parenchyma without delayed diagnosis of incomplete resection.

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Section: Discussionmentioning

confidence: 58%

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

et al. 2018

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“…At the same time, laparoscopic Doppler ultrasound can reduce time of renal hilar isolation and improve the detection of renal hilar vessels [41]. On the other hand, the application of fluorescence imaging during MIPN has been widely studied, and this technique can assist in the identification of tumors and provide real-time guidance during resection as well as guiding selective ischemia and assessing the margin [42]. The augmented reality technique provides clinicians subsurface structures through overlaying preoperative image data on the living surgery video [42].…”

Section: Intraoperative Imaging Techniquesmentioning

confidence: 99%

“…On the other hand, the application of fluorescence imaging during MIPN has been widely studied, and this technique can assist in the identification of tumors and provide real-time guidance during resection as well as guiding selective ischemia and assessing the margin [42]. The augmented reality technique provides clinicians subsurface structures through overlaying preoperative image data on the living surgery video [42]. Different intraoperative imaging techniques have their individual applications, as well as strengths and weaknesses, which are summarized in Table 3 [42].…”

Section: Intraoperative Imaging Techniquesmentioning

confidence: 99%

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

Cheng

Zhang

et al. 2020

Urol Int

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Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy are attracting increased attention from urologists. They can achieve the same effect of oncology control as radical nephrectomy; moreover, they can offer better preservation of renal function, thus obtaining longterm living benefits. The indications are also expanding, making it possible for larger and more difficult tumors. Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy can be performed by transperitoneal and retroperitoneal approaches, with their individual advantages and limitations. In addition, the renal tumor scoring systems have been widely used and studied in laparoscopic partial nephrectomy and robot-assisted partial nephrectomy. In order to better preserve renal function, the zero-ischemia technique is widely used. The application of intraoperative imaging technology provides convenience and greater benefits. Besides, whether minimal invasive partial nephrectomy can be performed without stop antiplatelet treatment is still disputed. Clinicians perform substantial exploration and practice to achieve the "trifecta" of surgery: complete resection of the tumor, maximum protection of renal function, and no complications.

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“…There are several scenarios where OCT may be beneficial in oncology, from the early detection of cancer to the monitoring of tumor response to different treatments …”

Section: New Intraoperative Imaging Technologies Overviewmentioning

confidence: 99%

New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision

Mascagni

Longo

Barberio

et al. 2018

Journal of Surgical Oncology

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Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy

Cited by 62 publications

References 66 publications

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

MRI as a tool to assess surgical margins and pseudocapsule features directly following partial nephrectomy for small renal masses

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision

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