V04-07 3D SELECTIVE ARTERIAL CLAMPING IN ROBOT ASSISTED PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyAdrenal & Renal Oncology I (Nephron Sparing Surgery) (V04)1 Sep 2021V04-07 3D SELECTIVE ARTERIAL CLAMPING IN ROBOT ASSISTED PARTIAL NEPHRECTOMY Pieter De Backer, Melle Belgium, Saar Vermijs, Charles Van Praet, Sarah Vandenbulcke, Maryse Lejoly, Stefanie Vanderschelden, Pieter De Visschere, Alexandre Mottrie, Charlotte Debbaut, and Karel Decaestecker Pieter De BackerPieter De Backer More articles by this author , Melle BelgiumMelle Belgium More articles by this author , Saar VermijsSaar Vermijs More articles by this author , Charles Van PraetCharles Van Praet More articles by this author , Sarah VandenbulckeSarah Vandenbulcke More articles by this author , Maryse LejolyMaryse Lejoly More articles by this author , Stefanie VanderscheldenStefanie Vanderschelden More articles by this author , Pieter De VisscherePieter De Visschere More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , Charlotte DebbautCharlotte Debbaut More articles by this author , and Karel DecaesteckerKarel Decaestecker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002000.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Selective arterial clamping (SAC) in Robot-Assisted Partial Nephrectomy (RAPN) can be considered a good intermediate between an off-clamp and fully-clamped approach, minimizing the risks of bleeding, prolonged warm ischemia time (WIT) and renal function decline. Preoperative estimation of renal perfusion zones and SAC-strategy can be impractical when solely based on CT or MRI images. We describe our mathematical 3D model to preoperatively estimate and visualize the 3D SAC strategy and compare this with peri-operative outcomes of two RAPN cases. METHODS: Two patients with a single renal tumor (PADUA score 6 and 8) underwent RAPN with 3D SAC prediction. 3D arterial tree, parenchyma and tumor volume segmentations derived from preoperative four phase CT scans are inputted in our in-house developed software package. This assigns every voxel of the scanned renal volume to its nearest vessel. The result is an interactive virtual 3D render of different SAC strategies. Intra-operative visualization is performed using the TilePro™ function. After SAC, indocyanine green (ICG) is administered to check the prediction of the algorithm by assessing the renal surface information using Firefly™ fluorescence imaging. RESULTS: Both RAPN conducted according to the preoperatively defined SAC strategy were completed successfully. Dissection time was 19 and 35 minutes for the second generation renal arteries on a total surgical console time of respectively 100 and 110 minutes. Trifecta was achieved twice: negative cancer margin, no renal function decrease (GFR at day 30: resp. >60 and 89 ml/min) and no urological postoperative complications at day 1 and day 30. WIT was 15 and 18 minutes, blood loss 200 and 50 ml, respectively. Histopathology showed oncocytoma in both cases. The ICG fluorescence confirmed correct algorithmic predictions at the surface level. Respectively 16% and 57% of the renal volume was estimated to be clamped simultaneously. The model allowed for bloodless enucleation initiation away from the remaining perfused tumor zone and predicted correctly where bleeding was to be expected inside the parenchyma. CONCLUSIONS: We demonstrated the added value of 3D reconstructions and our predefined 3D SAC strategy in selected cases. A direct distance algorithm specifies the clamping positions and the corresponding perfusion zones. Visualizing this SAC strategy on the 3D reconstruction of the kidney and surrounding structures allows for a targeted approach during the RAPN procedure. Further validation of our predictions is needed and a more systematic approach to measure clinical outcome is desired. Source of Funding: VLAIO mandate HBC.2020.2252 / Orsi Academy / Ipsen Research Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e293-e293 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pieter De Backer More articles by this author Melle Belgium More articles by this author Saar Vermijs More articles by this author Charles Van Praet More articles by this author Sarah Vandenbulcke More articles by this author Maryse Lejoly More articles by this author Stefanie Vanderschelden More articles by this author Pieter De Visschere More articles by this author Alexandre Mottrie More articles by this author Charlotte Debbaut More articles by this author Karel Decaestecker More articles by this author Expand All Advertisement Loading ...