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

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 Dimensio...

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Main Authors: 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
Format: Article
Language:English
Published: Elsevier 2022-07-01
Series:Asian Journal of Urology
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Online Access:http://www.sciencedirect.com/science/article/pii/S2214388222000455
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author 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
author_facet 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
author_sort Daniele Amparore
collection DOAJ
description 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.
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spelling doaj-art-2c914f6d95084f74ae2f21ce2db326ac2025-08-20T03:48:32ZengElsevierAsian Journal of Urology2214-38822022-07-019326327110.1016/j.ajur.2022.06.003Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot studyDaniele Amparore0Angela Pecoraro1Federico Piramide2Paolo Verri3Enrico Checcucci4Sabrina De Cillis5Alberto Piana6Mariano Burgio7Michele Di Dio8Matteo Manfredi9Cristian Fiori10Francesco Porpiglia11Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands; Corresponding author. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, NetherlandsDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; European Association of Urology (EAU) Young Academic Urologists (YAU) Uro-technology and SoMe Working Group, Arnhem, NetherlandsDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDivision of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, ItalyObjective: 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.http://www.sciencedirect.com/science/article/pii/S2214388222000455Three-dimensionalKidney cancerRenal cell carcinomaRoboticLaparoscopicNephron-sparing surgery
spellingShingle 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
Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot study
Asian Journal of Urology
Three-dimensional
Kidney cancer
Renal cell carcinoma
Robotic
Laparoscopic
Nephron-sparing surgery
title Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot study
title_full Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot study
title_fullStr Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot study
title_full_unstemmed Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot study
title_short Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot study
title_sort three dimensional imaging reconstruction of the kidney s anatomy for a tailored minimally invasive partial nephrectomy a pilot study
topic Three-dimensional
Kidney cancer
Renal cell carcinoma
Robotic
Laparoscopic
Nephron-sparing surgery
url http://www.sciencedirect.com/science/article/pii/S2214388222000455
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