馬蹄腎関連尿管骨盤部移行部閉鎖症に対する腹腔鏡下腎盂形成術における3次元画像再構築技術：症例シリーズ研究
Shuya Kandori1, Kosuke Kojo1, Akio Hoshi2
1Department of Urology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Ibaraki, Japan.
Purpose:
Horseshoe kidney (HSK) with ureteropelvic junction obstruction (UPJO) is a rare clinical condition. For successful pyeloplasty in these patients, preoperative anatomic mapping is crucial. Therefore, we investigated the utility of three-dimensional (3D) image reconstruction technology for accurate preoperative and intraoperative procedure planning.
Methods:
We retrospectively investigated the surgical outcomes of 6 patients who underwent laparoscopic pyeloplasty (LP) for HSK-associated UPJO at our hospital between October 2017 and October 2019. Next, we examined the concordance between intraoperative findings and 3D images reconstructed with SYNAPSE VINCENT® software.
Results:
Preoperative 3D-CT imaging clearly visualized the unique anatomy of HSK, including arteries and veins, and the vessels crossing the UPJ anteriorly could be detected before surgery in 5 of 6 patients. Importantly, these images completely coincided with intraoperative findings. In fact, no intraoperative complications or conversions to open surgery were needed. Moreover, all patients are currently asymptomatic and have no major sequelae at a mean follow-up of 29.9 months (range 15.4 to 39.7).
Conclusions:
The present study suggests the potential utility of 3D image reconstruction technology in performing LP through detailed preoperative mapping of complex renal anatomies, such as in HSK.
