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Holographic 3D renal segments reconstruction protects renal function by promote choice of selective renal artery clamping during robot-assisted partial nephrectomy

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World Journal of Urology Aims and scope Submit manuscript

Abstract

Objective

To investigate the impact of selective artery clamping (SAC) and main artery clamping (MAC) during robot-assisted partial nephrectomy (RAPN) on renal function and the influence of holographic three-dimensional (3D) reconstruction of renal segments on the selection between SAC and MAC.

Methods

This retrospective observational study included patients who underwent RAPN at First Hospital Affiliated to the Army Medical University between December 2016 and July 2022. According to the clamping methods, the patients were divided into the SAC group and the MAC group. The primary outcome was renal function.

Results

A total of 422 patients (194 in the SAC group and 228 in the MAC group) were included. The RAPN procedures were all completed successfully. The patients in SAC group had less glomerular filtration rate (GFR) decline in the affected kidney (8.6 ± 7.0 ml/min vs. 18.7 ± 10.9 ml/min, P < 0.001) and minor estimated glomerular filtration rate (eGFR) decrease (4.3 ± 10.5 ml/min vs. 12.6 ± 12.1 ml/min, P < 0.001) than those in MAC group. Among 37 patients with baseline renal insufficiency, the GFR decline of the affected kidney in the SAC subgroup was significantly lower than in the MAC subgroup (5.5 ± 6.5 ml/min vs. 14.3 ± 9.2 ml/min, P = 0.002). The proportion of patients who underwent 3D reconstruction was significant higher in the SAC group than in the MAC group. (65.46% vs. 28.07%, P < 0.001).

Conclusion

The SAC technique during RAPN may serve as a protective measure for renal function, while the implementation of holographic 3D renal segment reconstruction technique may facilitate optimal selection of SAC.

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Availability of data and materials

All original data are available in Southwest Hospital of the Third Military Medical University (Army Medical University).

References

  1. Vartolomei MD, Remzi M, Fajkovic H et al (2022) Robot-assisted partial nephrectomy mid-term oncologic outcomes: a systematic review. J Clin Med 11(20):6165

    Article  PubMed  PubMed Central  Google Scholar 

  2. Patel AR, Eggener SE (2011) Warm ischemia less than 30 minutes is not necessarily safe during partial nephrectomy: every minute matters. Urol Oncol 29:826–828

    Article  PubMed  Google Scholar 

  3. Novara G, La Falce S, Kungulli A et al (2016) Robot-assisted partial nephrectomy. Int J Surg 36:554–559

    Article  PubMed  Google Scholar 

  4. Bouzouita A, Saadi A, Hermi A (2021) Cadaveric study of arterial renal anatomy and its surgical implications in partial nephrectomy. Surg Radiol Anat 43:1449–1459

    Article  PubMed  Google Scholar 

  5. Lanchon C, Arnoux V, Fiard G et al (2018) Super-selective robot-assisted partial nephrectomy using near-infrared flurorescence versus early-unclamping of the renal artery: results of a prospective matched-pair analysis. Int Braz J Urol 44:53–62

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fujiki T, Nishimura R, Mase S et al (2019) Accurate detection of renal leukemic involvement in children using 3-D computed tomography modeling. Pediatr Int 61:679–687

    Article  PubMed  Google Scholar 

  7. Elhadidi M, Aldahouk A, Shawky M et al (2019) Computer-guided calvarial mono-cortical bone blocks harvest: a novel approach for three-dimensional alveolar reconstruction of atrophic maxilla. Clin Implant Dent Relat Res 21:85–93

    Article  PubMed  Google Scholar 

  8. Wang Z, Qi L, Yuan P et al (2017) Application of three-dimensional visualization technology in laparoscopic partial nephrectomy of renal tumor: a comparative study. J Laparoendosc Adv Surg Tech A 27:516–523

    Article  PubMed  Google Scholar 

  9. Stevens PE, Levin A (2013) Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158:825–830

    Article  PubMed  Google Scholar 

  10. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853

    Article  PubMed  Google Scholar 

  11. Hafeez AR, Idrees MK, Akhtar SF (2016) Accuracy of GFR estimation formula in determination of glomerular filtration rate in kidney donors: comparison with 24 h urine creatinine clearance. Saudi J Kidney Dis Transpl 27:320–325

    Article  PubMed  Google Scholar 

  12. Mitropoulos D, Artibani W, Biyani CS et al (2018) Validation of the Clavien-Dindo grading system in urology by the European association of urology guidelines ad hoc panel. Eur Urol Focus 4:608–613

    Article  PubMed  Google Scholar 

  13. Lin P, Wu M, Gu H et al (2021) Comparison of outcomes between laparoscopic and robot-assisted partial nephrectomy for complex renal tumors: RENAL score ≥7 or maximum tumor size >4 cm. Minerva Urol Nephrol 73(2):154–164

    Article  PubMed  Google Scholar 

  14. Shao P, Qin C, Yin C et al (2011) Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes. Eur Urol 59:849–855

    Article  PubMed  Google Scholar 

  15. Desai MM, de Castro Abreu AL, Leslie S et al (2014) Robotic partial nephrectomy with superselective versus main artery clamping: a retrospective comparison. Eur Urol 66:713–719

    Article  PubMed  Google Scholar 

  16. Cacciamani GE, Medina LG, Gill TS et al (2019) Impact of renal hilar control on outcomes of robotic partial nephrectomy: systematic review and cumulative meta-analysis. Eur Urol Focus 5:619–635

    Article  PubMed  Google Scholar 

  17. Paulucci DJ, Rosen DC, Sfakianos JP et al (2017) Selective arterial clamping does not improve outcomes in robot-assisted partial nephrectomy: a propensity-score analysis of patients without impaired renal function. BJU Int 119:430–435

    Article  PubMed  Google Scholar 

  18. Long JA, Fiard G, Giai J et al (2022) Superselective ischemia in robotic partial nephrectomy does not provide better long-term renal function than renal artery clamping in a randomized controlled trial (EMERALD): should we take the risk? Eur Urol Focus 8:769–776

    Article  PubMed  Google Scholar 

  19. Zhang L, Wu B, Zha Z et al (2018) Comparison of selective and main renal artery clamping in partial nephrectomy of renal cell cancer: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 97:e11856

    Article  PubMed  Google Scholar 

  20. Amparore D, Piramide F, Checcucci E et al (2023) Three-dimensional virtual models of the kidney with colored perfusion regions: a new algorithm-based tool for optimizing the clamping strategy during robot-assisted partial nephrectomy. Eur Urol

  21. Amparore D, Piramide F, Verri P et al (2023) New generation of 3D virtual models with perfusional zones: perioperative assistance for the best pedicle management during robotic partial nephrectomy. Curr Oncol 30:4021–4032

    Article  PubMed  PubMed Central  Google Scholar 

  22. De Backer P, Vermijs S, Van Praet C et al (2023) A novel three-dimensional planning tool for selective clamping during partial nephrectomy: validation of a perfusion zone algorithm. Eur Urol 83:413–421

    Article  PubMed  Google Scholar 

  23. Porpiglia F, Checcucci E, Amparore D et al (2020) Three-dimensional augmented reality robot-assisted partial nephrectomy in case of complex tumours (PADUA ≥10): a new intraoperative tool overcoming the ultrasound guidance. Eur Urol 78:229–238

    Article  PubMed  Google Scholar 

  24. Grosso AA, Di Maida F, Tellini R et al (2021) Robot-assisted partial nephrectomy with 3D preoperative surgical planning: video presentation of the florentine experience. Int Braz J Urol 47:1272–1273

    Article  PubMed  PubMed Central  Google Scholar 

  25. Grosso AA, Marìn DM, Di Maida F et al (2022) Robotic partial nephrectomy with En bloc removal of a renal vein thrombus for multiple cT3a renal cell carcinoma lesions. Eur Urol Open Sci 44:33–36

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bianchi L, Cercenelli L, Bortolani B et al (2022) 3D renal model for surgical planning of partial nephrectomy: a way to improve surgical outcomes. Front Oncol 12:1046505

    Article  PubMed  PubMed Central  Google Scholar 

  27. Porpiglia F, Fiori C, Checcucci E et al (2018) Hyperaccuracy three-dimensional reconstruction is able to maximize the efficacy of selective clamping during robot-assisted partial nephrectomy for complex renal masses. Eur Urol 74:651–660

    Article  PubMed  Google Scholar 

  28. Weight CJ, Larson BT, Fergany AF et al (2010) Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 183:1317–1323

    Article  PubMed  Google Scholar 

  29. Mir MC, Ercole C, Takagi T et al (2015) Decline in renal function after partial nephrectomy: etiology and prevention. J Urol 193:1889–1898

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Author notes

  1. Ling Wei, Cong Wang and Jian Fu have contributed equally.

Authors and Affiliations

  1. Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China

    Ling Wei, Cong Wang, Jian Fu, Xiaozhou Zhou, Peng He, Xuemei Li, Lang Lang, Chunxia Li & Yongquan Wang

  2. Department of Urology, Tibet CORPS Hospital of Chinese People’s Armed Police Forces, Lhasa, 850000, Tibet, China

    Tudan Qiangba

Authors
  1. Ling Wei
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  2. Cong Wang
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Contributions

YQW: protocol development, study concept and design, surgical procedure, critical revision of the manuscript for important intellectual content; LW: drafting of the manuscript, data management, analysis and interpretation of data; CW: acquisition of data, analysis and interpretation of data; JF: acquisition of data, statistical analysis; TDQ: acquisition of data; XZZ: acquisition of data; PH: acquisition of data; LL: acquisition of data; CXL: administrative, technical, or material support; XML: administrative, technical, or material support.

Corresponding author

Correspondence to Yongquan Wang.

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Conflict of interest

The authors declared no conflict of interest.

Ethical approval

The study protocol was approved by the Ethics Committee of the First Hospital Affiliated to the Army Medical University (approval No. KY202113).

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All participants of our study have signed a consent form after receiving adequate information.

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All participants of our study have signed a consent form after receiving adequate information, and all personal information is anonymized before publication.

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Wei, L., Wang, C., Fu, J. et al. Holographic 3D renal segments reconstruction protects renal function by promote choice of selective renal artery clamping during robot-assisted partial nephrectomy. World J Urol 41, 2975–2983 (2023). https://doi.org/10.1007/s00345-023-04599-2

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  • DOI: https://doi.org/10.1007/s00345-023-04599-2

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