Off-clamp vs on-clamp robotic partial nephrectomy: Perioperative, functional and oncological outcomes from a propensity-score matching between two high-volume centers

et al. 2020

Preprint

Background: Advances in three dimensional (3D) reconstruction and printing technology have fueled a rapidly growing interest in its applications in the field of urology. To our knowledge, the experience on the use of 3D reconstruction to facilitate zero-ischemia partial nephrectomy (PN) remains sparse and the role of 3D reconstruction is still needed to be defined. This study aimed to assess the role of 3D reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN). Methods: A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017and March 2018 who underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) preoperatively were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiological findings were directly correlated with intraoperative surgical findings at laparoscopy. Baseline, perioperative variables and the rate of accurate tumor feeding artery orientation were compared between groups.Results: All the procedures were performed successfully without conversion to main renal artery clamping. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P>0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P<0.05). 3D reconstruction group resulted in more accurate dissection of tumor artery (91.7%) as compared to conventional CTA (84.2%). There were no statistical differences in the baseline characteristics and renal function outcomes between two groups.Conclusions: 3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation that may facilitate tumor resection during zero-ischemia LPN for renal tumors.None.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

et al. 2020

Preprint

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

et al. 2020

Preprint

Background: Advances in three dimensional (3D) reconstruction and printing technology have fueled a rapidly growing interest in its applications in the field of urology. To our knowledge, the experience on the use of 3D reconstruction to facilitate zero-ischemia partial nephrectomy (PN) remains sparse and the role of 3D reconstruction is still needed to be defined. This study aimed to assess the role of 3D reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN). Methods: A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 who underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) preoperatively were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiological findings were directly correlated with intraoperative surgical findings at laparoscopy. Baseline, perioperative variables and the rate of accurate tumor feeding artery orientation were compared between groups. Results: All the procedures were performed successfully without conversion to main renal artery clamping. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P>0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P<0.05). 3D reconstruction group resulted in more accurate dissection of tumor artery (91.7%) as compared to conventional CTA (84.2%). There were no statistical differences in the baseline characteristics and renal function outcomes between two groups. Conclusions: 3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation that may facilitate tumor resection during zero-ischemia LPN for renal tumors.

“…advances in surgical technique now make it possible to eliminate global ischemia completely during partial nephrectomy (PN), such as zero-ischemia PN, unclamped "minimal-margin" PN and clampless techniques [2][3][4]. However, zero-ischemia LPN is a technically challenging operation.…”

mentioning

confidence: 99%

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

et al. 2020

Preprint

Background: With the development of three dimensional (3D) reconstruction and printing technology, it has been widely using in the field of urology. However, there have been few studies reporting the role of 3D reconstruction in zero-ischemia partial nephrectomy (PN). The aim of this study was to assess the role of 3D reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN).Methods: A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 who underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) preoperatively were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiological findings were directly correlated with intraoperative surgical findings at laparoscopy. Baseline, perioperative variables and the rate of accurate tumor feeding artery orientation were compared between groups.Results: All LPNs were completed without conversion to renal hilar clamping or open surgery. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P>0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P<0.05) and the rate of accurate tumor feeding artery dissection was higher in the 3D group (91.7%) in comparison with the CTA group (84.2%). The baseline characteristics and renal function outcomes had no statistical differences between groups. Conclusions: 3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation about tumor feeding arteries that may facilitate tumor resection during zero-ischemia LPN for renal tumors.