New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy

被引:12
作者
Amparore, Daniele [1 ]
Piramide, Federico [1 ]
Verri, Paolo [1 ]
Checcucci, Enrico [2 ]
De Cillis, Sabrina [1 ]
Piana, Alberto [1 ]
Volpi, Gabriele [2 ]
Burgio, Mariano [1 ]
Busacca, Giovanni [1 ]
Colombo, Marco [1 ]
Fiori, Cristian [1 ]
Porpiglia, Francesco [1 ]
机构
[1] Univ Turin, San Luigi Gonzaga Hosp, Dept Urol, I-10043 Orbassano, Italy
[2] FPO IRCCS, Candiolo Canc Inst, Dept Surg, I-10060 Candiolo, Italy
关键词
three-dimensional imaging; robotic surgery; nephron-sparing surgery; kidney cancer; surgical anatomy; AUGMENTED REALITY; KIDNEY; IMPACT; PRECISION; SURGERY; DISPLAY;
D O I
10.3390/curroncol30040304
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generation of 3DVMs, which consider the perfusion volumes of the kidney. Patients listed for RAPN from 2021 to 2022 were recruited. A selective clamping strategy was designed and intraoperatively performed based on the specifically generated 3DVMs. The effectiveness of selective clamping was evaluated using near-infrared-fluorescence imaging (NIRF) and 3DVM. Perfusion areas extensions were compared, and relevant preoperative characteristics were analyzed. In 61 of 80 (76.25%) cases, selective clamping was performed. The concordance between the 3DVM areas and the NIRF-enhanced areas was verified (k = 0.91). According to the distribution of perfused areas crossing the tumor, there were one, two, three, four, and five crossing areas, with relative perfusion rates of 13.75%, 35%, 32.5%, 13.75%, and 5%, respectively. Lesion diameter and mesorenal location were the only factors related to a higher number (>3) of perfusion volumes crossing the lesion. The implementation of mathematical algorithms to 3DVMs allows for precise estimation of the perfusion zone of each arterial branch feeding the organ, leading to the performance of safe and effective pedicle management planning.
引用
收藏
页码:4021 / 4032
页数:12
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