Intraoperative Surgeon-Performed Ultrasound in Complex Partial Nephrectomy: Insights from Challenging Renal Tumors

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Nephron-sparing surgery (NSS) for renal tumors requires precise tumor localization and resection.
• Intraoperative ultrasound (IOUS) offers real-time, high-resolution imaging to aid surgeons.
• Complex cases, including solitary kidneys and recurrent tumors, present unique surgical challenges.

Purpose of the Study:

• To evaluate the impact and utility of intraoperative ultrasound (IOUS) in partial nephrectomy.
• To compare outcomes in patients with solitary kidneys or tumor recurrence versus those with a contralateral kidney.
• To assess the role of IOUS in complex renal tumor resections.

Main Methods:

• Retrospective analysis of 152 patients undergoing partial nephrectomy (January 2019 - December 2024).
• Patients divided into Group A (solitary kidney/recurrence) and Group B (contralateral kidney).
• Comparison of perioperative and oncological outcomes, noting IOUS use (20% of cases).

Main Results:

• IOUS was used more frequently in Group A (75%) than Group B (10%), indicating its use in higher-complexity cases (p < 0.001).
• Positive surgical margin rates were low and similar between IOUS and non-IOUS groups (3.2% vs. 1.7%; p = 0.54).
• IOUS facilitated better intraoperative tumor delineation for high-risk tumors without increasing complications.

Conclusions:

• Intraoperative ultrasound enhances surgical precision and oncologic safety in partial nephrectomies, particularly for complex renal tumors.
• IOUS is a valuable adjunct in conservative renal surgery, especially for solitary kidneys, recurrent disease, or multifocal tumors.
• The use of IOUS should be considered standard practice in challenging NSS scenarios.