[Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling?]

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Assessing zero ischemia kidney tumor removal techniques.
• Comparing enucleation, enucleoresection, and partial nephrectomy.
• Evaluating the role of 3D tumor reconstruction in surgical planning.

Purpose of the Study:

• To compare zero ischemia enucleation/enucleoresection with traditional partial nephrectomy for localized renal tumors.
• To determine the utility of 3D tumor modeling in preoperative planning for these procedures.

Main Methods:

• 83 patients with localized renal tumors underwent laparoscopic surgery.
• Patients were divided into three groups: enucleation (n=41), enucleoresection (n=31), and partial nephrectomy (n=11).
• 3D tumor models were created using Amira software for surgical planning.

Main Results:

• Laparoscopic approaches (transperitoneal and retroperitoneal) were utilized.
• 3D modeling provided insights into tumor-related structures, vessel anatomy, and renal pelvis relationships.
• Surgery duration was significantly reduced when parenchyma location was known via 3D modeling (58.3 min vs. 87.6 min).
• Blood loss varied based on tumor location and vessel proximity, with 3D modeling aiding in prediction.
• No renal vessel clamping or conversion to open surgery was required; no complications occurred in the enucleation group.

Conclusions:

• 3D modeling offers significant advantages for urologists in planning renal tumor interventions.
• Tumor enucleation is presented as an optimal partial nephrectomy method, enabling dissection near the renal sinus with minimal complications.