Русский
Computer-assisted laparoscopic surgery for renal carcinoma
DOI: https://dx.doi.org/10.18565/urology.2018.3.30-38
Yu.G. Alyaev, E.S. Sirota, E.A. Bezrukov, R.B. Sukhanov
I.M. Sechenov First MSMU (Sechenov University) of Minzdrav of Russia, Research Institute for Uronephrology and Human Reproductive Health, Moscow, Russia
Aim. To investigate the effectiveness and benefits of using 3D planning and virtual surgery in the management of patients with localized renal carcinoma undergoing laparoscopic surgery.
Materials and methods. A retrospective analysis was performed on 558 patients with renal cell carcinoma (RCC) who underwent surgical treatment at the Clinic of Urology, I.M. Sechenov First MSMU from January 2012 to May 2017. Of them, 244 (43.7%) and 314 (56.3%) patients underwent laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN), respectively. In addition to the standard diagnostic work-up, 248 (44.4%) patients underwent multispiral computed tomography (MSCT) for 3D modeling and virtual surgery using the 3D modeling program Amira. Matched pairs of patients with and without 3D planning were selected based on similarity of urologists’ experience in performing the operation, the size and location of the tumor (relative to the renal segment, anterior and posterior surfaces), and the surgical approach. As a result, two homogeneous subgroups of patients were chosen comprising those who underwent LRN (22 pairs of patients) and LPN
(53 pairs of patients).
Results. Patients with RCC who underwent LPN with 3D planning had a significant advantage over patients without virtual planning: by warm ischemia time 12.0±6.4 min (p=0.010), operative time 113.4±39.4 min (p=0.0001), blood loss 102.8±98.2 ml (p=0.001). Among patients with RCC who underwent LRN, the subgroup with 3D planning also had an advantage: operative time was 135.2±27 and 202.9±55.5 min (p=0.0001), blood loss was 143.2±137,4 and 472,0±395,4 ml (p=0,014), and regarding the rate of intraoperative (p=0,017) and postoperative (p=0,017) complications.
Conclusion. The use of computer-assisted 3D planning and virtual operations improves immediate results of surgery in RCC patients undergoing organ-sparing and organ-removing laparoscopic surgery.
Materials and methods. A retrospective analysis was performed on 558 patients with renal cell carcinoma (RCC) who underwent surgical treatment at the Clinic of Urology, I.M. Sechenov First MSMU from January 2012 to May 2017. Of them, 244 (43.7%) and 314 (56.3%) patients underwent laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN), respectively. In addition to the standard diagnostic work-up, 248 (44.4%) patients underwent multispiral computed tomography (MSCT) for 3D modeling and virtual surgery using the 3D modeling program Amira. Matched pairs of patients with and without 3D planning were selected based on similarity of urologists’ experience in performing the operation, the size and location of the tumor (relative to the renal segment, anterior and posterior surfaces), and the surgical approach. As a result, two homogeneous subgroups of patients were chosen comprising those who underwent LRN (22 pairs of patients) and LPN
(53 pairs of patients).
Results. Patients with RCC who underwent LPN with 3D planning had a significant advantage over patients without virtual planning: by warm ischemia time 12.0±6.4 min (p=0.010), operative time 113.4±39.4 min (p=0.0001), blood loss 102.8±98.2 ml (p=0.001). Among patients with RCC who underwent LRN, the subgroup with 3D planning also had an advantage: operative time was 135.2±27 and 202.9±55.5 min (p=0.0001), blood loss was 143.2±137,4 and 472,0±395,4 ml (p=0,014), and regarding the rate of intraoperative (p=0,017) and postoperative (p=0,017) complications.
Conclusion. The use of computer-assisted 3D planning and virtual operations improves immediate results of surgery in RCC patients undergoing organ-sparing and organ-removing laparoscopic surgery.
Keywords: three-dimensional technologies, virtual planning, nephrectomy, partial nephrectomy, kidney cancer, laparoscopy
About the Autors
Corresponding author: E.S. Sirota – Ph.D., Senior Researcher at the Research Institute for Uronephrology and Human Reproductive Health, Head of Operating Unit of the Clinic of Urology, I.M. Sechenov First MSMU (Sechenov University), Moscow, Russia; e-mail: essirota@mail.ru
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