Abstract
Resection of completely endophytic renal tumors is a huge challenge for surgeons due to a lack of definite visual clues, especially in the laparoscopic approach. Three-dimensional (3D) kidney models, which can illustrate the clear relationship between renal masses and surrounding health tissues, were considered as reliable tools for understanding renal tumor characteristics in previous studies. We hypothesized that 3D kidney models can be used not only for planning but also for navigating laparoscopic partial nephrectomy (LPN) in patients with completely endophytic renal tumors. In this study, we successfully constructed five cases of 3D kidney models for assisted planning and navigation for LPN in endophytic renal tumors. The renal masses and surrounding normal parenchyma of the patient-specific 3D models were dyed by different colorants for clear illustration. All patients experienced acceptable perioperative outcomes, and no patient suffered serious relative complications. The 3D kidney models were considered as a reliable tool based on clinical outcome and postoperative questionnaire results. This study is the first report of 3D kidney models for patients with completely endophytic tumors. 3D kidney models can aid surgeons in understanding the characteristics of renal tumors and potentially support assisted planning and performance of LPN in endophytic tumor cases.
Highlights
Five patients with completely endophytic renal tumors successfully underwent 3D kidney models-assisted LNP performed by the same surgeon with good prevention against damnification of surrounding structures, including the renal arteriovenous and collection system, and without significant intraoperative and postoperative complications
Warm ischemia time was under 30 minutes from 18 minutes to 27 minutes, which met the safety range for renal function protection of under 30 min
We hypothesized that 3D printing models have an effect on understanding tumor characteristics and perioperative surgical planning and benefit real-time navigation of laparoscopic partial nephrectomy (LPN) in completely endophytic renal tumors, which shortens warm ischemia time and increases clinical outcome
Summary
A surgical assistant carried the models and rotated them for alignment with the laparoscopic screen image (Fig. 3). This procedure can aid in targeting the operative position based on renal anatomical landmarks and dimensions determined by preoperative planning (Fig. 3). A questionnaire consisting of open-ended questions from ordinal 10-point rating scales (1-not at all useful/ not at all realistic/poor, 10-very useful/very realistic/excellent) was plotted from surgical participants[3] In this questionnaire, 6 items, including overall evaluation (Q1), realism (graphics (Q2a)/details of vasculature and collecting system (Q2b)/ tumors size and inter-relationship (Q2c)) and usefulness (for perioperative understanding and planning (Q3a)/ for LNP performance (Q3b)), were asked to assess face and content validity. Patient Demographics Age (y)/Sex BMI ASA score Tumor characteristics Tumor histology R.E.N.A.L score (R/E/N/A/L) Pathologic stage Clinical Outcomes Conversion surgical modality (T)ransperitoneal vs (R)etroperitoneal Operative time (minutes) Warm ischemia time (minutes) Estimated intraoperative blood loss (ml) Estimated postoperative blood loss (ml) Increased creatinine level (mg/dL) Complications Clavien grade ≥ II Tumor margin status Three-dimensional model deviation (cm) (tumor model size/ tumor size)
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