ロボット支援部分切除術における術中3D再構成モデルのリアルタイム表示
Shunsuke Miyamoto1, Hiroyuki Shikuma2, Ryo Tasaka2
1Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan. sm0025@hiroshima-u.ac.jp.
Objective:
Robot-assisted partial nephrectomy (RAPN) is a widely used technique for treating renal tumors. However, accurate identification of tumor locations and precise surgical planning remain challenging, particularly in cases with complex anatomy or tumors in difficult-to-reach areas. This study evaluated the usefulness of intraoperative real-time 3D reconstruction models for RAPN.
Methods:
We analyzed the data of 57 patients who underwent RAPN using 3D reconstruction models (3D-R group) and 173 patients who underwent RAPN without these models (control group). The models were generated from the preoperative Computed tomography images and displayed on a monitor in the operating room to plan surgical approaches and guide tumor dissection. Propensity score matching was performed to compare the surgical outcomes between the two groups.
Results:
The use of real-time 3D reconstruction models significantly improved surgical outcomes in the propensity score-matched cohort. The ischemia time was shorter in the 3D-R RAPN group than in the control group (p = 0.019). Significantly fewer overall and major complications were observed in the 3D-R RAPN group (p = 0.023 and p = 0.041, respectively). Additionally, the 3D-R RAPN group achieved the trifecta status at a significantly higher rate than the control group (p = 0.005).
Conclusions:
3D reconstruction models are valuable tools for guiding RAPN, leading to shorter warm ischemia times, fewer complications, and a higher trifecta achievement rate, thereby enhancing the overall quality of care of patients undergoing RAPN.
