СПОСОБ ПРОЕКТИРОВАНИЯ ХИРУРГИЧЕСКОГО ДОСТУПА ДЛЯ АДРЕНАЛЭКТОМИИ ПРИ ПОМОЩИ 3D-МОДЕЛИРОВАНИЯ

Abstract

In the literature, insufficient attention is paid to the preoperative planning of the approach to adrenal glands using the modern capabilities of computed tomography (CT) navigation. The aim of the work was to demonstrate the possibilities of designing safe access for adrenalectomy using three-dimensional printed models based on preoperative CT data. The possibilities of preoperative access design for edrenalectomy were studied in 362 adrenal tumor patients who underwent CT imaging on Aquillion 64 (Toshiba, Japan), followed by post-processor image processing, construction of multi-plane and 3D reconstructions. All patients were divided into retrospective (n=157) and prospective (n=205) groups. In 3 clinical cases, preoperative access design was supplemented by the creation of a three-dimensional printed model of the adrenal gland with a tumor using the Slicer 4.10.1 software. Reliable anthropometric (body mass index, body shape) and CT-criteria for designing surgical access to the left and right adrenals were determined: diameter of formation; tumor syntopy in relation to the walls of the inferior vena cava; the length of the central adrenal vein and the place where it flows into the inferior vena cava; the location of the tumor relative to the inferior vein of the right lobe of the liver, as well as relative to the gate of the right kidney; location near the aortic-renal vascular triangle, gate of the left kidney and spleen vessels. Three patients with a borderline number of risk criteria for the development of vascular complications associated with the technical difficulties of adrenalectomy (for right adrenals≥4, for left adrenals≥3) underwent CT-segmentation of images with the subsequent creation of three-dimensional plates - a model of an NP tumor with neighboring organs and vessels. Preoperative CT design of the approach, taking into account the risk criteria for complications and the use of 3-D printed models, can reasonably apply endoscopic and open options for adrenalectomy, significantly improving the immediate results of treatment of patients.