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Identification of Recurrent Anatomical Clusters Using Three-dimensional Virtual Models for Complex Renal Tumors with
Daniele Amparore1,2, Federico Piramide1, Angela Pecoraro1,2
1Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
Background:
Some renal tumors have an imperative indication for nephron-sparing surgery (NSS), such as in cases of chronic kidney disease and bilateral complex tumors.
Objective:
To demonstrate the degree to which three-dimensional virtual model (3DVM) assistance can be helpful in planning the surgical strategy for high-complexity renal masses with an imperative indication for NSS.
Design Setting And Participants:
Three patients with high-complexity renal masses with unusual anatomy and an imperative indication for NSS were prospectively selected across 2020 and 2021 at our institution. All patients underwent contrast-enhanced computed tomography from which a 3DVM was obtained.
Surgical Procedure:
Robot-assisted partial nephrectomy with 3DVM augmented reality guidance.
Measurements:
Demographics and tumor-related features were recorded. Data for intraoperative, pathological, and functional assessments were collected for all three patients.
Results And Limitations:
Two of the three patients harbored bilateral renal tumors. The third patient presented with a renal mass in the left kidney and contralateral renal hypoplasia (right-split renal function of 25%). All of the patients demonstrated similar anatomical and tumor features on 3DVMs, with potentially independent vascularization and drainage for the lower pole. In one patient the upper pole of the kidney was spared, exiting in a functionally excluded hydrocalyx, while in the other two cases the upper pole was removed together with the lesion. The spared portion of the kidney retained vascularization, as demonstrated by intraoperative ultrasound and indocyanine green injection. The small sample size and short follow-up are the main limitations of the study.
Conclusions:
3DVMs, especially for complex renal masses with an imperative indication for NSS, allow planning of the surgical strategy on the basis of the anatomical characteristics of the organ in which the tumor is growing.
Patient Summary:
Three-dimensional models help in defining the best surgical strategy for kidney tumors, especially for complex tumors that require surgery to spare as much of the kidney as possible.
Insights
Three-dimensional virtual models aid surgical planning for complex kidney tumors requiring nephron-sparing surgery. These models help define optimal strategies to preserve kidney function in challenging cases.
Area of Science:
- Urology
- Surgical Oncology
- Medical Imaging
Background:
- Nephron-sparing surgery (NSS) is crucial for renal tumors in patients with chronic kidney disease or bilateral tumors.
- Complex renal masses necessitate precise surgical planning to maximize kidney preservation.
Purpose of the Study:
- To evaluate the utility of three-dimensional virtual models (3DVMs) in planning NSS for high-complexity renal masses.
- To assess the effectiveness of 3DVM-assisted surgical strategy development.
Main Methods:
- Prospective selection of three patients with high-complexity renal masses and imperative indication for NSS.
- Creation of 3DVMs from contrast-enhanced computed tomography scans.
- Robot-assisted partial nephrectomy utilizing 3DVM augmented reality guidance.
Main Results:
- 3DVMs revealed complex anatomical features, including independent vascularization in some cases.
- Surgical strategies were adapted based on 3DVM insights, with varying degrees of upper pole resection.
- Intraoperative assessments confirmed preserved vascularization in remaining kidney portions.
Conclusions:
- Three-dimensional virtual models are valuable tools for planning surgical strategies for complex renal masses.
- 3DVMs facilitate a detailed understanding of anatomical characteristics for optimizing NSS outcomes.
