PD18-03 CONSOLE-INTEGRATED REAL-TIME THREE-DIMENSIONAL IMAGE OVERLAY NAVIGATION FOR ROBOT-ASSISTED PARTIAL NEPHRECTOMY WITH SELECTIVE ARTERIAL CLAMPING: EARLY SINGLE-CENTER EXPERIENCE WITH 25 CASES

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Malignant Disease II1 Apr 2015PD18-03 CONSOLE-INTEGRATED REAL-TIME THREE-DIMENSIONAL IMAGE OVERLAY NAVIGATION FOR ROBOT-ASSISTED PARTIAL NEPHRECTOMY WITH SELECTIVE ARTERIAL CLAMPING: EARLY SINGLE-CENTER EXPERIENCE WITH 25 CASES Junya Furukawa, Hideaki Miyake, Kazushi Tanaka, and Masato Fujisawa Junya FurukawaJunya Furukawa More articles by this author , Hideaki MiyakeHideaki Miyake More articles by this author , Kazushi TanakaKazushi Tanaka More articles by this author , and Masato FujisawaMasato Fujisawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.688AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To preserve a favorable renal function following partial nephrectomy (PN), selective clamping of the arterial branches feeding tumor tissues during PN has been performed; however, it is still difficult to apply this technique to challenging cases, particularly those with intrarenal hilar masses. The objective of this study was to describe our early experience with robot-assisted partial nephrectomy (RAPN) incorporating selective arterial clamping using an image overlay navigation system. METHODS Three-dimensional images were reconstructed from computed tomography with an open source processing software, OsiriX, and were directly visualized on the screen of a da Vinci surgeon□fs console with TilePro multi-input display functions after rendering parameters were adjusted to exclude or enhance imaging signals to obtain more suitable information. Using this system providing appropriate real-time 3D volume-rendered images of key anatomical structures adjusted to the operative filed, RAPN with selective arterial clamping was performed in 25 patients with renal tumors. RESULTS The intraoperative image overlay navigation system made it possible to clearly show the tumor position and vascular supply within the console□fs field of view, and significantly facilitate selective arterial clamping during RAPN in all 25 cases without conversion to conventional RAPN with main renal artery clamping. In this series, the mean warm ischemia time and estimated blood loss in these 25 cases were 21.6 min and 35.0 ml, respectively. No patient was pathologically diagnosed with a positive surgical margin. Furthermore, the estimated glomerular filtration rate was decreased by 8.2 and 9.4 ml/min/1.73 m2 at 1 and 4 weeks after surgery, respectively, and 3 patients developed complication corresponding to Clavien grade 2 ≥. CONCLUSIONS Despite it being on early experience with the initial 25 cases, our precise segmental clamping technique under the guidance of this imaging system is feasible and safe for performing RAPN, resulting in the achievement of satisfactory perioperative clinical outcomes, since the surgeon could create a bloodless field maintaining adequate visibility during tumor excision by restricting ischemia to the tumor and its adjacent tissue. Collectively, these findings suggest that RAPN with selective arterial clamping using this innovative imaging navigation system could be an alternative to conventional RAPN. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e387 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Junya Furukawa More articles by this author Hideaki Miyake More articles by this author Kazushi Tanaka More articles by this author Masato Fujisawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...