V10-03 3D VIRTUAL MODELS APPLICATION FOR AN ANATOMIC-FUNCTIONAL APPROACH TO HIGHLY COMPLEX RENAL TUMORS WITH IMPERATIVE INDICATIONS TO NEPHRON SPARING SURGERY

Abstract

You have accessJournal of UrologyCME1 May 2022V10-03 3D VIRTUAL MODELS APPLICATION FOR AN ANATOMIC-FUNCTIONAL APPROACH TO HIGHLY COMPLEX RENAL TUMORS WITH IMPERATIVE INDICATIONS TO NEPHRON SPARING SURGERY Daniele Amparore, Angela Pecoraro, Federico Piramide, Paolo Verri, Enrico Checcucci, Sabrina De Cillis, Alberto Piana, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Daniele AmparoreDaniele Amparore More articles by this author , Angela PecoraroAngela Pecoraro More articles by this author , Federico PiramideFederico Piramide More articles by this author , Paolo VerriPaolo Verri More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Sabrina De CillisSabrina De Cillis More articles by this author , Alberto PianaAlberto Piana More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For some renal tumors, the indication to nephron sparing surgery (NSS) becomes imperative, such as chronic kidney disease (CKD) and bilateral tumours. For these patients three-dimensional virtual models (3DVMs) assistance could allow to reshape the surgical strategy, considering the anatomy of the organ in a perspective of postoperative real organ functioning instead of focusing the surgery on the tumor excision alone. METHODS: Three patients with high complexity renal masses, with abnormal anatomy and imperative indication to NSS were selected. All patients performed contrast-enhanced CT from which a 3DVM was obtained. Using such technological tools, it was possible to set the surgical strategy considering the anatomical kidney details, leading the surgeon to plan the sacrifice of the upper portion of the whole organ in light of its irrelevant contribution to the postoperative global renal function even if spared. RESULTS: Two out of three patients harbored bilateral renal tumors. The third patient presented a renal mass in the left kidney and a contralateral renal hypoplasia (right split renal function of 25%). All of them demonstrated similar anatomical and tumoral features, with a potential independent vascularization and drainage for the lower pole. In one of them the upper pole of the kidney was spared, exiting in an hydrocalyx functionally excluded, while in the other two cases it was removed together with the lesion. The spared portion of the kidney-maintained vascularization, as demonstrated by intraoperative ultrasound and indocyanine green injection. CONCLUSIONS: 3DVMs, especially in case of complex renal masses with imperative indication to NSS, allow to plan the surgical strategy on the basis of the anatomical characteristics of the organ in which the tumor grows, focusing the attention on the effective functional gain of the surgery, even considering sacrificing portions of the organ technically preservable but functionally not useful. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e849 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniele Amparore More articles by this author Angela Pecoraro More articles by this author Federico Piramide More articles by this author Paolo Verri More articles by this author Enrico Checcucci More articles by this author Sabrina De Cillis More articles by this author Alberto Piana More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF DownloadLoading ...