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Preoperative planning and real-time assisted navigation by three-dimensional individual digital model in partial nephrectomy with three-dimensional laparoscopic system

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Abstract

Objective

To evaluate the feasibility and effectiveness of preoperative planning and real-time assisted surgical navigation for three-dimensional laparoscopic partial nephrectomy under the guidance of three-dimensional individual digital model (3D-IDM) created using three-dimensional medical image reconstructing and guiding system (3D-MIRGS).

Patients and methods

Between May 2012 and February 2014, 44 patients with cT1 renal tumors underwent retroperitoneal laparoscopic partial nephrectomy (LPN) using a three-dimensional laparoscopic system. The 3D-IDMs were created using the 3D-MIRGS in 21 patients (3D-MIRGS group) between February 2013 and February 2014. After preoperative planning, operations were real-time assisted using composite 3D-IDMs, which were fused with two-dimensional retrolaparoscopic images. The remaining 23 patients underwent surgery without 3D-MIRGS between May 2012 and February 2013; 14 of these patients were selected as a control group. Preoperative aspects and dimensions used for an anatomical score, “radius; exophytic/endophytic; nearness; anterior/posterior; location” nephrometry score, tumor size, operative time (OT), segmental renal artery clamping (SRAC) time, estimated blood loss (EBL), postoperative hospitalization, the preoperative serum creatinine level and ipsilateral glomerular filtration rate (GFR), as well as postoperative 6-month data were compared between groups.

Results

All the SRAC procedures were technically successful, and each targeted tumor was excised completely; final pathological margin results were negative. The OT was shorter (159.0 vs. 193.2 min; \(p < 0.001\)), and EBL (148.1 vs. 176.1 mL; \(p < 0.001\)) was reduced in the 3D-MIRGS group compared with controls. No statistically significant differences in SRAC time or postoperative hospitalization were found between the groups. Neither group showed any statistically significant increases in serum creatinine level or decreases in ipsilateral GFR postoperatively.

Conclusions

Preoperative planning and real-time assisted surgical navigation using the 3D-IDM reconstructed from 3D-MIRGS and combined with the 3D laparoscopic system can facilitate LPN and result in precise SRAC and accurate excision of tumor that is both effective and safe.

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References

  1. Winfield HN, Donovan JF, Godet AS, Clayman RV (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 7(6):521–526

    Article  CAS  PubMed  Google Scholar 

  2. Shao P, Qin C, Yin C, Meng X, Ju X, Li J, Lv Q, Zhang W, Xu Z (2011) Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes. Eur Urol 59(5):849–855

    Article  PubMed  Google Scholar 

  3. Shichiri Y, Takao N, Oida T, Kanamaru H, Shimizu Y (2004) Laparoscopic partial nephrectomy for a renal tumor with tumor-feeding artery ligation: left renal cell carcinoma in the posterior mid zone. Int J Urol 11(11):1019–1023

    Article  PubMed  Google Scholar 

  4. Nohara T, Fujita H, Yamamoto K, Kitagawa Y, Gabata T, Namiki M (2008) Modified anatrophic partial nephrectomy with selective renal segmental artery clamping to preserve renal function: a preliminary report. Int J Urol 15(11):961–966

    Article  PubMed  Google Scholar 

  5. Xu Y, Shao P, Zhu X, Lv Q, Liu W, Xu H, Zhu Y, Yang G, Tang L, Yin C (2013) Three-dimensional renal CT angiography for guiding segmental renal artery clamping during laparoscopic partial nephrectomy. Clin Radiol 68(11):e609–616

    Article  PubMed  Google Scholar 

  6. Ng CK, Gill IS, Patil MB, Hung AJ, Berger AK, de Castro Abreu AL, Nakamoto M, Eisenberg MS, Ukimura O, Thangathurai D, Aron M, Desai MM (2012) Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur Urol 61(1):67–74

    Article  PubMed  Google Scholar 

  7. Shao P, Tang L, Li P, Xu Y, Qin C, Cao Q, Ju X, Meng X, Lv Q, Li J, Zhang W, Yin C (2012) Precise segmental renal artery clamping under the guidance of dual-source computed tomography angiography during laparoscopic partial nephrectomy. Eur Urol 62(6):1001–1008

    Article  PubMed  Google Scholar 

  8. Ukimura O, Nakamoto M, Gill IS (2012) Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy. Eur Urol 61(1):211–217

    Article  PubMed  Google Scholar 

  9. Wunderlich H, Reichelt O, Schubert R, Zermann DH, Schubert J (2000) Preoperative simulation of partial nephrectomy with three-dimensional computed tomography. BJU Int 86(7):777–781

    Article  CAS  PubMed  Google Scholar 

  10. Shao P, Tang L, Li P, Xu Y, Qin C, Cao Q, Ju X, Meng X, Lv Q, Li J, Zhang W, Yin C (2013) Application of a vasculature model and standardization of the renal hilar approach in laparoscopic partial nephrectomy for precise segmental artery clamping. Eur Urol 63(6):1072–1081

    Article  PubMed  Google Scholar 

  11. Huang MW, Liu SM, Zheng L, Shi Y, Zhang J, Li YS, Yu GY, Zhang JG (2012) A digital model individual template and CT-guided 125I seed implants for malignant tumors of the head and neck. J Radiat Res 53(6):973–977

    Article  PubMed Central  PubMed  Google Scholar 

  12. Gu J, Bo XF, Xiong CY, Wu AW, Zhang XP, Li M, An Q, Fang J, Li J, Zhang X, Wang HY, Gao F, You WC (2006) Defining pelvic factors in sphincter-preservation of low rectal cancer with a three-dimensional digital model of pelvis. Dis Colon Rectum 49(10):1517–1526

    Article  PubMed  Google Scholar 

  13. Lusch A, Bucur PL, Menhadji AD, Okhunov Z, Liss MA, Perez-Lanzac A, McDougall EM, Landman J (2014) Evaluation of the impact of three-dimensional vision on laparoscopic performance. J Endourol 28(2):261–266

    Article  PubMed  Google Scholar 

  14. Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279

    Article  PubMed  Google Scholar 

  15. Springer C, Hoda M, Fajkovic H, Pini G, Mohammed N, Fornara P, Greco F (2013) Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long-term oncological and functional outcomes in 340 patients. BJU Int 111(2):281–288

    Article  PubMed  Google Scholar 

  16. Gill IS, Kamoi K, Aron M, Desai MM (2010) 800 Laparoscopic partial nephrectomies: a single surgeon series. J Urol 183(1):34–41

    Article  PubMed  Google Scholar 

  17. Aron M, Turna B (2009) Laparoscopic partial nephrectomy: newer trends. Indian J Urol 25(4):516–522

    Article  PubMed Central  PubMed  Google Scholar 

  18. Richstone L, Montag S, Ost M, Reggio E, Permpongkosol S, Kavoussi LR (2008) Laparoscopic partial nephrectomy for hilar tumors: evaluation of short-term oncologic outcome. Urology 71(1):36–40

    Article  PubMed  Google Scholar 

  19. Turna B, Aron M, Gill IS (2008) Expanding indications for laparoscopic partial nephrectomy. Urology 72(3):481–487

    Article  PubMed  Google Scholar 

  20. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I, Permpongkosol S, Weight CJ, Kaouk JH, Kattan MW, Novick AC (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178(1):41–46

    Article  PubMed  Google Scholar 

  21. Teber D, Guven S, Simpfendörfer T, Baumhauer M, Güven EO, Yencilek F, Gözen AS, Rassweiler J (2009) Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in vitro and in vivo results. Eur Urol 56(2):332–338

    Article  PubMed  Google Scholar 

  22. Lasser MS, Doscher M, Keehn A, Chernyak V, Garfein E, Ghavamian R (2012) Virtual surgical planning: a novel aid to robot-assisted laparoscopic partial nephrectomy. J Endourol 26(10):1372–1379

    Article  PubMed  Google Scholar 

  23. Yan Y, Ma LL (2012) Zero ischemia partial nephrectomy. Chin Med J (Engl) 125(21):3909–3911

    Google Scholar 

  24. Cicione A, Autorino R, Breda A, De Sio M, Damiano R, Fusco F, Greco F, Carvalho-Dias E, Mota P, Nogueira C, Pinho P, Mirone V, Correia-Pinto J, Rassweiler J, Lima E (2013) Three-dimensional vs standard laparoscopy: comparative assessment using a validated program for laparoscopic urologic skills. Urology 82(6):1444–1450

    Article  PubMed  Google Scholar 

  25. Buchs NC, Volonte F, Pugin F, Toso C, Morel P (2013) Three-dimensional laparoscopy: a step toward advanced surgical navigation. Surg Endosc 27:692–693

    Article  PubMed  Google Scholar 

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Conflict of interest

All of the authors (Dongwen Wang, Bin Zhang, Xiaobin Yuan, Xuhui Zhang and Chen Liu) declare no conflicts of interest.

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Authors and Affiliations

  1. First College of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China

    Dongwen Wang, Bin Zhang, Xiaobin Yuan, Xuhui Zhang & Chen Liu

  2. Department of Urology, First Hospital of Shanxi Medical University, No. 56, Xinjiannan Road, Taiyuan, 030001, Shanxi, China

    Dongwen Wang, Bin Zhang, Xiaobin Yuan, Xuhui Zhang & Chen Liu

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  1. Dongwen Wang
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  2. Bin Zhang
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  3. Xiaobin Yuan
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  4. Xuhui Zhang
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Correspondence to Dongwen Wang.

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Wang, D., Zhang, B., Yuan, X. et al. Preoperative planning and real-time assisted navigation by three-dimensional individual digital model in partial nephrectomy with three-dimensional laparoscopic system. Int J CARS 10, 1461–1468 (2015). https://doi.org/10.1007/s11548-015-1148-7

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  • DOI: https://doi.org/10.1007/s11548-015-1148-7

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