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Related Experiment Video

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A Novel Three-dimensional Planning Tool for Selective Clamping During Partial Nephrectomy: Validation of a Perfusion

Pieter De Backer1, Saar Vermijs2, Charles Van Praet3

  • 1Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium; IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent Belgium; ORSI Academy, Melle, Belgium.

European Urology
|February 3, 2023
PubMed
Summary

A new algorithm accurately maps kidney perfusion zones for robot-assisted partial nephrectomy (RAPN), improving surgical planning. This tool helps surgeons identify precise arteries for selective clamping, enhancing patient outcomes.

Keywords:
Indocyanine greenPartial nephrectomyPerfusion zone algorithmRenal cell carcinomaSelective clampingThree-dimensional models

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Area of Science:

  • Urology
  • Medical Imaging
  • Surgical Technology

Background:

  • Robot-assisted partial nephrectomy (RAPN) requires detailed knowledge of patient-specific renal vasculature for selective clamping.
  • Current imaging techniques provide a basis for understanding renal anatomy but may lack precision for intraoperative decision-making.

Purpose of the Study:

  • To validate an in-house developed algorithm designed to provide patient-specific three-dimensional (3D) renal perfusion zone information.
  • To assess the accuracy of the algorithm in predicting ischemic zones during selective clamping in RAPN.

Main Methods:

  • Twenty-five patients undergoing RAPN were included in the study.
  • Three-dimensional models were generated from preoperative CT scans to visualize predicted ischemic zones.
  • Indocyanine green (ICG) was used intraoperatively to delineate the true ischemic zone, which was compared to the algorithm's predictions.

Main Results:

  • The algorithm demonstrated high accuracy, with 92% of cases deemed suitable for planning selective clamping strategies.
  • Quantitative assessments showed strong agreement between predicted and true ischemic zones (Metric 1: 4.28/5, Metric 2: 4.14/5).
  • Limitations include ICG's surface-only evaluation and the current need for contrast-enhanced CT.

Conclusions:

  • The developed algorithm is a valuable tool for enhancing the accuracy of selective clamping during RAPN.
  • Further prospective studies are necessary to establish the definitive clinical added value of this technology.