Preoperative simulation of partial nephrectomy with three‐dimensional computed tomography

Abstract

Objective To evaluate prospectively the accuracy of computer-aided three-dimensional (3D) volumerendered computed tomography (CT) in determining the appropriate anatomical limits (tumour size, tumour location, multifocality and vascular supply) and as a potential tool in the preoperative simulation of nephron-sparing surgery (NSS) in patients with small-volume renal cell carcinoma (RCC). Patients and methods The study included 36 patients who underwent transperitoneal radical nephrectomy for RCC of <4 cm diameter. Helical CT was undertaken before surgery and the extent of the tumour, the course of major renal arteries and veins, and the relationship of the tumour to the collecting system were shown by 3D volume-rendered CT. The CT ®ndings were compared with the pathological results of all kidney specimens, obtained using 3-mm stepsections. Results Before nephrectomy, 39 renal tumours were identi®ed in the 36 patients; three renal lesions of <4 mm were not detected. All main venous branches and 42 of 43 arteries were identi®ed by 3D volumerendered CT. Knowing these features, a partial nephrectomy was simulated; a surgical lesion to the pelvicalyceal or vascular system which would have been produced by the simulated surgery was displayed in colour on the simulated surface of the section. Conclusion Computer simulation provided an excellent 3D reconstruction of all kidneys, including the tumour, vasculature and renal hilum, allowing a signi®cantly better preoperative evaluation of the renal mass. Visualizing possible resection margins and predicting the operative risks seem to be major advantages of this new method, especially when preparing for complex surgery. Reconstructed 3D CT appears to be a useful tool for de®ning the indications for and limitations of NSS.

3-D Imaging and Simulation for Nephron Sparing Surgical Training

“…They showed that 3-D CT could accurately identify the tumor characteristics and vascular system anatomy. Of 39 renal tumors and 43 renal arteries, only three tumors, each of which measured less than 4 mm, and one accessory renal artery were not identified preoperatively [33]. Similar results were reported by Coll et al on 60 patients evaluated with 3-D rendered CT before PN.…”

A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy

“…The corticomedullary phase is used to assess the arterial system (number of renal arteries, feeding mass arteries) and the urographic phase to assess proximity to and involvement of the renal collecting system [14]. Three-dimensional CT reconstruction depicts the vascular and renal mass anatomy in a format familiar to surgeons and serves to guide PN surgery, especially in complex cases [15,16]. …”

Three‐dimensional printed model of bilateral Wilms tumor: A useful tool for planning nephron sparing surgery

“…3D‐CT angiography has been used as a tool for the preoperative evaluation of NSS . Computer simulation with 3D reconstruction of kidney, including the tumor, vasculature, and renal hilum, has allowed a significantly better preoperative evaluation of the renal mass …”

“…9 Computer simulation with 3D reconstruction of kidney, including the tumor, vasculature, and renal hilum, has allowed a significantly better preoperative evaluation of the renal mass. 10 The incorporation of 3D printing to develop simulation models and training devices for surgical education may prove to be a valuable resource to oncological pediatric surgery trainees. 11 3D technology can provide a topographical map of the kidney surface and complete views of intrarenal anatomy.…”