Better specificity and less ischemia: three-dimensional reconstruction is superior to routine computed tomography angiography in navigation of super-selective clamping robot-assisted laparoscopic partial nephrectomy

Wu，Chong1; Guo，Shengjie1; Zhuo，Shuiqing2; Wang，Yanjun1; Ye，Yunlin1; Li，Zaishang3,4; Mou，Yonggao5; Yang，Xiangyun1; Zhang，Zhiling1; Dong，Pei1; Zhou，Fangjian1; Han，Hui1

2023

10.21037/tau-22-865

Translational Andrology and Urology   影响因子和分区

2223-4683

2223-4691

Background: Available technologies could be used to guide surgeons in controlling highly selective tumor-bearing arteries robot-assisted laparoscopic partial nephrectomy (RALPN). Methods: Patients undergoing RALPN (from September 2018 to January 2020) for intermediate-high complex renal tumor (R.E.N.A.L. score ≥7) who underwent abdominal computed tomography (CT) scan with angiography and hyper-accuracy 3-dimensional reconstruction (H3DR). All patients underwent high-resolution CT scan with angiography and H3DR with special software, based on which two kinds of highly selective arterial clamp protocols were made for each patient and analyzed independently by two urologists and two radiologists to confirm which renal arterial branch was supplying the tumor. We chose the optimized clamping protocol with the principle of the minimized ischemic regions. During the operation, meticulous microdissection and clip ligation of the specific vascular branch was guided by optimized protocol [H3DR or computed tomography angiography (CTA) reconstruction], according to the in vivo anatomy (identified by intraoperative ultrasound). Results: Of 82 patients, the minimum-ischemic regions planning completed rate (MIRPCR) of preoperative planning with H3DR (90.2%) was higher than that with CTA (34.1%) (P<0.01). H3DR identified 78 high-order arteries (70.3%), whereas CTA identified 33 (29.7%) high-order arteries (P<0.001). H3DR detected a more optimal blocking option in 51 cases that were either missed (n=13) or misclassified by CTA (n=38). A total of 18 cases (56.3%) were converted to H3DR-guided occurred in CTA-guided surgery [5 (10.0%) occurred in group H3DR to CTA, P<0.01]. Moreover, in the CTA-guided group, the separation of renal hilum was avoided in 14 of 19 (73.7%) cases, whereas in the H3DR-guided group, it was avoided in 60 of 63 (95.3%) cases. Conclusions: For patients undergoing RALPN, H3DR-guided surgery compared with standard CTA-guided surgery has higher accuracy and feasibility in controlling arterial branches supplying the tumor and intraoperative surgical navigation. Additionally, it reduces the ischemic lesion area and simplifies vascular isolation steps, thus decreasing procedural difficulty.

partial nephrectomy (PN) robotics Three-dimensional reconstruction-guided surgery zero-ischemia

SCI

英语

其他

Guangzhou Science and Technology Program key projects[201704020133];

Endocrinology & Metabolism ; Urology & Nephrology

Andrology ; Urology & Nephrology

WOS:000950633100005

AME PUBLISHING COMPANY

2-s2.0-85147779094

Scopus

1.Department of Urology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat-sen University,Guangzhou,China
2.Department of Radiology,Sun Yat-sen University Cancer Center,Guangzhou,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat-sen University,Guangzhou,China
3.Department of Urology,Shenzhen People’s Hospital,Second Clinic Medical College of Jinan University,Shenzhen,China
4.Department of Urology,First Affiliated Hospital,Southern University of Science and Technology,Minimally Invasive Urology of Shenzhen Research and Development Center of Medical Engineering and Technology,Shenzhen,China
5.Department of Neurosurgery/Neuro-oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat-sen University,Guangzhou,China

Wu，Chong,Guo，Shengjie,Zhuo，Shuiqing,et al. Better specificity and less ischemia: three-dimensional reconstruction is superior to routine computed tomography angiography in navigation of super-selective clamping robot-assisted laparoscopic partial nephrectomy[J]. Translational Andrology and Urology,2023,12(1):97-111.

Wu，Chong.,Guo，Shengjie.,Zhuo，Shuiqing.,Wang，Yanjun.,Ye，Yunlin.,...&Han，Hui.(2023).Better specificity and less ischemia: three-dimensional reconstruction is superior to routine computed tomography angiography in navigation of super-selective clamping robot-assisted laparoscopic partial nephrectomy.Translational Andrology and Urology,12(1),97-111.

Wu，Chong,et al."Better specificity and less ischemia: three-dimensional reconstruction is superior to routine computed tomography angiography in navigation of super-selective clamping robot-assisted laparoscopic partial nephrectomy".Translational Andrology and Urology 12.1(2023):97-111.