Robotic-assisted partial nephrectomy: initial experience with 3D printing

Abstract

Introduction: The creation of 3D printed silicone models has several purposes, one of which is to provide augmented reality (AR), thanks to the imaging and visualization methods that serve as aids in “surgical planning”. They enable precise analysis of the anatomy at the site to be treated and can influence surgical strategy change or decision-making. 
 Materials and methods: The present case report describes the surgical planning carried out with a 3D printed model, in a 40-year-old patient incidentally diagnosed with a T2aN0M0 CS I left kidney tumor, measuring 20 mm, that was slightly exophytic, with a RENAL Score of 4a.
 Results: Total surgery duration was 180 min, with a console time of 120 min, blood loss of 50cc, and warm ischemia time of 12 min. No drain was placed, hospital stay was 2 days, and there were no complications.
 Discussion: Visualizing the anatomic characteristics on the model enabled surgical programming to be carried out, along with guided dissection and selective clamping that did not involve the entire renal hilum. Three-dimensional models are based on multi-slice digital tomography images that are converted to real scale and then printed with different materials, achieving an anatomic representation of the organ to be treated. 
 Conclusions: That type of planning favors better understanding of the surgical anatomy of the tumor and improved decision-making. Case series on different anatomic variations, as well as other organs, should be carried out.