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Three-dimensional imaging reconstruction of the kidney’s anatomy for a tailored minimally invasive partial nephrectomy:A pilot study

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Asian Journal of Urology 2022年第3期9卷 263-271页

作者： Daniele Amparore Angela Pecoraro Federico Piramide Paolo Verri Enrico Checcucci Sabrina De Cillis Alberto Piana Mariano Burgio Michele Di Dio Matteo Manfredi Cristian Fiori Francesco Porpiglia Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoTurinItaly European Association of Urology(EAU)Young Academic Urologists(YAU)renal Cancer Working Group ArnhemNetherlands European Association of Urology(EAU)Young Academic Urologists(YAU)Uro-technology and SoMe Working Group ArnhemNetherlands Division of Urology Department of SurgerySS Annunziata HospitalCosenzaItaly

Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present study.For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed.These patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without 3DVMs.Multivariable logistic regression models were used to predict the margin,ischemia,and complication score achievement.Results:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance.The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses.They can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.

关键词： Three-dimensional Kidney cancer renal cell carcinoma Robotic Laparoscopic Nephron-sparing surgery complex renal mass

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A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

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Asian Journal of Urology 2023年第4期10卷 390-406页

作者： Savio Domenico Pandolfo Clara Cerrato Zhenjie Wu Antonio Franco Francesco Del Giudice Alessandro Sciarra Paolo Verze Giuseppe Lucarelli Ciro Imbimbo Sisto Perdonà Edward E.Cherullo Francesco Porpiglia Ithaar H.Derweesh Riccardo Autorino Department of Urology Rush University Medical CenterChicagoILUSA Department of Neurosciences Reproductive Sciences and Odontostomatology“Federico II”UniversityNaplesItaly Department of Urology University of VeronaVeronaItaly Department of Urology Changhai HospitalNaval Medical UniversityShanghaiChina European Association of Urology(EAU)Young Academic Urologists(YAU)renal Cancer Working Group Arnhemthe Netherlands Department of Urology Sant’Andrea HospitalLa Sapienza UniversityRomeItaly Department of Maternal-Infant and Urologic Sciences La Sapienza UniversityPoliclinico Umberto I HospitalRomeItaly Department of Medicine and Surgery Scuola Medica SalernitanaUniversity of SalernoFiscianoItaly Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Department Uro-Gynecology IRCCS G.Pascale FoundationNaplesItaly Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly Department of Urology University of California San DiegoLa JollaCAUSA

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

关键词： Robot-assisted partial nephrectomy complex renal mass Solitary kidney Larger tumors(cT2-T3) Endophytic and hilar mass Recurrent tumor Simultaneous and multiple tumor

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