MP26-18 PRELIMINARY EXPERIENCE WITH HYPER-ACCURACY IMAGE-GUIDED ROBOTIC PARTIAL NEPHRECTOMY WITH NON-GLOBAL ISCHEMIA TECHNIQUE

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2018MP26-18 PRELIMINARY EXPERIENCE WITH HYPER-ACCURACY IMAGE-GUIDED ROBOTIC PARTIAL NEPHRECTOMY WITH NON-GLOBAL ISCHEMIA TECHNIQUE Francesco Porpiglia, Riccardo Bertolo, Daniele Amparore, Enrico Checcucci, and Cristian Fiori Francesco PorpigliaFrancesco Porpiglia More articles by this author , Riccardo BertoloRiccardo Bertolo More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , and Cristian FioriCristian Fiori More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.876AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During robotic partial nephrectomy (RPN) selective clamping of renal arterial branches can avoid global ischemia. It is usually preoperatively planned but based on bidimensional CT scan images. 3D Virtual Reconstruction (3DVR) based on CT scan can give more information on vascular anatomy of the kidney, allowing to more precisely plan the selective clamping. Aim of the study was to evaluate the utility of the 3DVR in the planning of selective clamping during RPN. METHODS From 12/16 to 04/17, all patients with complex renal masses (PADUA score >10) suitable for RPN were prospectively enrolled in the study and underwent 1 mm slices contrast-enchanced CT angiography. A 3DVR of the kidney, tumor and vascular anatomy were performed by bio-engenieers by dedicated software. Selective clamping was planned, with virtual simulation of the effects of regional ischemia. In order to evaluate the potential advantages of 3DVR in the planning of selective clamping, the patients (Group A) were matched with a cohort of patients with complex renal masses treated with RPN from 01/16 to 11/16, in which the clamping technique was planned without 3DVR (Group B). For both groups demographics, perioperative variables and complications were recorded. RESULTS 21 patients were included in Group A, whilst 31 in Group B. The two groups resulted comparable in terms of demographic (age, BMI, ASA score, Charlson Comorbidity Index) and preoperative variables (lesion size at CT scan, PADUA score). Intraoperative variables and complications are reported in Table. As showed in the Table for the planning of the clamping strategy the use of 3DVR allowed to avoid global ischemia and collecting system opening in a higher percentage of cases if compared with a standard 2D CT scan imaging (23.8 vs 80.6% - p=0.0002, and 14.2% vs 41.3% - p=0.06, respectively). CONCLUSIONS The results of this preliminary study show that the 3DVR could help the surgeon in the pre-operative RPN planning, in order to perform a selective clamping technique, minimizing global renal ischemia and collecting system opening, often necessary in case of complex renal masses. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e344 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Francesco Porpiglia More articles by this author Riccardo Bertolo More articles by this author Daniele Amparore More articles by this author Enrico Checcucci More articles by this author Cristian Fiori More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...