The role of three-dimensional reconstruction in laparoscopic partial nephrectomy for complex renal tumors

Abstract

Background To evaluate the role of three-dimensional (3D) reconstruction technique in renal function protection and ipsilateral parenchymal mass preserved after laparoscopic partial nephrectomy (LPN) in patients with complex renal tumor (R.E.N.A.L.score ≥ 8). Methods A retrospective study enrolling 49 patients who suffered from RCC and underwent LPN at our center, from October 1, 2017, to October 31, 2018. Twenty-one patients (group A) underwent LPN with the 3D reconstruction technique before surgery, and the other 28 patients (group B) not. Preoperative and postoperative ipsilateral parenchymal mass volume and ipsilateral glomerular filtration rate (GFR) were analyzed 3–5 days prior and 3 months after PN. In order to compare the two groups, Mann-Whitney U test and chi-square tests were performed. The main limitation of this technique is that the volume calculations are partly performed manually. Results All patients’ median renal score was 10 with no difference between the two groups (P = 0.89), and the median tumor size of the two groups was 3.2 cm (group A) and 3.3 cm (group B) respectively (P = 0.14). In addition, the median warm ischemia time of the two groups was 21 min (group A) and 26 min (group B) (P = 0.003). In group A and group B, the rate of preserved global GFR was 88% and 86% (P = 0.06), preserved ipsilateral GFR was 80% and 77% (P = 0.01), and preserved ipsilateral parenchymal was 84% and 80% (P = 0.03) separately. Conclusion 3D reconstruction technique was a beneficial method for more renal function and more preserved renal parenchymal mass volume after LPN. Trial registration Yantai Yuhuangding Hospital, YHD[2017]212. Registered 1 January 2017 (prospectively registered), http://www.ytyhdyy.com/nav/103.htm.

Three-Dimensional Printing Assisted Laparoscopic Partial Nephrectomy vs. Conventional Nephrectomy in Patients With Complex Renal Tumor: A Systematic Review and Meta-Analysis

“…To reduce the pooled result of heterogeneity, we consecutively omitted the included studies individually. After Wang et al's study (14) was excluded, the heterogeneity of the intraoperative blood loss declined (SMD = −0.29; 95% CI = −0.46 to −0.13, I 2 = 49.8%, P = 0.044; Figure 4C).…”

“…The basic characteristics of all 10 included studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) were summarized and are shown in Table 1. All studies were published between 2017 and 2020.…”

“…All included studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) reported operation time. The pooled results of the meta-analysis showed that the 3D-preoperative assessment shortened the operation time (SMD = −0.42; 95% CI = −0.70 to −0.14, I 2 = 65.5%, P = 0.002; Figure 2A) compared to conventional 2D-preoperative assessment surgeries.…”

“…Five studies (11,(13)(14)(15)(16) provided data on the warm ischemia time. The pooled meta-analysis results showed that the use of 3D-preoperative assessment had a shortened warm ischemia time (SMD = −0.97; 95% CI = −1.64 to −0.30, I 2 = 88.3%, P = 0.000; Figure 2B) in comparison with the traditional 2D-preoperative assessment surgeries.…”

“…All studies (11,(13)(14)(15)(16)(18)(19)(20)(21)(22) reported a positive surgical margin. Overall, no significant differences were found between the two groups (OR = 0.58; 95% CI = 0.15-2.23, I 2 = 0.0%, P = 0.959; Figure 2E).…”