Novel Intraoperative Navigation Using Ultra-High-Resolution CT in Robot-Assisted Partial Nephrectomy

Abstract

To assess the perioperative and short-term functional outcomes of robot-assisted partial nephrectomy (RAPN) with intraoperative navigation using an ultra-high-resolution computed tomography (UHR-CT) scanner, we retrospectively analyzed 323 patients who underwent RAPN using an UHR-CT or area-detector CT (ADCT). Perioperative outcomes and the postoperative preservation ratio of estimated glomerular filtration rate (eGFR) were compared. After the propensity score matching, we evaluated 99 patients in each group. Although the median warm ischemia time (WIT) was less than 25 min in both groups, it was significantly shorter in the UHR-CT group than in the ADCT group (15 min vs. 17 min, p = 0.032). Moreover, the estimated blood loss (EBL) was significantly lower in the UHR-CT group than in the ADCT group (33 mL vs. 50 mL, p = 0.028). However, there were no significant intergroup differences in the postoperative preservation ratio of eGFR at 3 or 6 months of follow-up (ADCT 91.8% vs. UHR-CT 93.5%, p = 0.195; and ADCT 91.7% vs. UHR-CT 94.0%, p = 0.160, respectively). Although no differences in short-term renal function were observed in intraoperative navigation for RAPN in this propensity score–matched cohort, this study is the first to demonstrate that UHR-CT resulted in a shorter WIT and lower EBL than ADCT.

Robotic versus Laparoscopic Partial Nephrectomy in the New Era: Systematic Review

“…One of the most popular is percutaneous cryoablation (PCA) [ 35 ], which is surrounded by controversies in the literature. While some studies suggest that RAPN and PCA have similar oncological outcomes in patients with small renal masses [ 36 ], others report that the recurrence rate is significantly higher after PCA vs RAPN [ 37 ], so it is essential to individualize the technique according to each patient and their neoplasm.…”

Patient‐specific simulations and navigation systems for partial nephrectomy

“…Takahara et al emphasized that success during RAPN depends on obtaining accurate information about the anatomical relationships between the tumor and the urinary vascular structures surrounding it and the precision of the 3DVR images used. 46 They used an ultra-high-resolution CT scanner to obtain 3DVR images for intraoperative navigation and compared it with conventional CT. The use of the ultra-highresolution CT scanner resulted in superior surgical outcomes in terms of the warm ischemic time and estimated intraoperative blood loss.…”

Novel Three-dimensional Workstation System for Intraoperative Navigation in Robot-Assisted Partial Nephrectomy

“…Dynamic contrast-enhanced CT of the kidney accurately confirms the anatomical relationship between the tumors, surrounding vascular structures, and the urinary tract through intravascular contrast enhancement of the arterial, venous, and excretion phases. We have previously reported a novel navigation system using an ultrahigh-resolution CT scanner that provides a shorter WIT and lower estimated blood loss (EBL) than areadetector CT. We concluded that this novel navigation system could be useful in patients undergoing RAPN [6]. Before RAPN surgery, 3D constructions of the renal tumor, vascular structures, and the urinary tract were performed using various image processing software based on these CT imaging data.…”