دورية أكاديمية
أعرض في EDS

Vascular perfusion 3D models guidance during robot-assisted partial nephrectomy: The end of empirical selective clamping era

التفاصيل البيبلوغرافية
العنوان: Vascular perfusion 3D models guidance during robot-assisted partial nephrectomy: The end of empirical selective clamping era
المؤلفون: Federico Piramide, Daniele Amparore, Enrico Checcucci, Sabrina De Cillis, Alberto Piana, Gabriele Volpi, Giovanni Busacca, Marco Colombo, Martina Mandaletti, Matteo Manfredi, Cristian Fiori, Francesco Porpiglia
المصدر: Urology Video Journal, Vol 18, Iss , Pp 100226- (2023)
بيانات النشر: Elsevier, 2023.
سنة النشر: 2023
المجموعة: LCC:Surgery
LCC:Diseases of the genitourinary system. Urology
مصطلحات موضوعية: Three-dimensional imaging, Robotic surgery, Nephron-sparing surgery, Kidney cancer, Surgical anatomy, Surgery, RD1-811, Diseases of the genitourinary system. Urology, RC870-923
الوصف: Objective: In the last years selective clamping strategies have been tested during partial nephrectomy (PN) to decrease the functional impairment linked to the ischemic damage. Recently, 3D virtual models (3DVM) have been reported to increase the accuracy of surgical strategy, leading to a higher rate of successful selective clamping. However, sometimes this empirical definition of vascular regions, based on arterial branches’ direction, fails intraoperatively and forcing towards a global clamping.Our aim is to present our new generation of 3DVM, built taking in consideration the different perfusion areas of the kidney instead of vascular regions empirically estimated, and to evaluate their accuracy intraoperatively and to assess if there are factors influencing the tumor location relative to these perfusion areas. Patients and surgical procedure: By using a mathematical tool, the Voronoi diagram, we calculate vascular perfusion regions of the organs and built the 3DVMs for all consecutive patients scheduled in our center for robot-assisted PN (RAPN) from 2019 to 2021. Based on the info given by the 3DVMs, a selective clamping strategy was planned end performed intraoperatively if feasible. To assess selective clamping success, near-infrared-fluorescence imaging (NIRF) was used. The concordance between virtual and real perfusion regions was automatically assessed by superimposition of 3DVMs over the real endoscopic view. The comparison between their extension was then assessed via k-Cohen test.At last, each lesion location was evaluated in relation to the number of its crossing perfused areas and a multivariate regression model (MLR) was fitted to assess potentially related preoperative factors. Results: 48 patients were enrolled. The renal pedicle management strategy was conducted as preoperatively planned in 100% of them. 68.7% of cases underwent selective clamping. The concordance between the NIRF enhanced areas and their corresponding 3DVM areas was confirmed (k = 0.94). Distribution of perfused areas crossing the tumor was as follows: 16.6%, 29.1%, 43.7%, 8.3%, 2.4% for 1, 2, 3, 4 and 5 crossing areas respectively. At MLR the clear cell histotype was the only factor related to a lower number (3) of perfusion areas. Conclusions: The implementation of mathematical algorithms to 3DVMs allows a precise estimation of the perfusion area of each arterial branch feeding the organ, leading to perform an effective pedicle management. Moreover, with this new technology it is possible to open new perspectives on the knowledge of renal tumors features, considering their growth in relation to their surrounding environment.
نوع الوثيقة: article
وصف الملف: electronic resource
اللغة: English
تدمد: 2590-0897
العلاقة: http://www.sciencedirect.com/science/article/pii/S2590089723000208Test; https://doaj.org/toc/2590-0897Test
DOI: 10.1016/j.urolvj.2023.100226
الوصول الحر: https://doaj.org/article/d6bd72c7f0de4b57991a21e55c13f9eeTest
رقم الانضمام: edsdoj.6bd72c7f0de4b57991a21e55c13f9ee
قاعدة البيانات: Directory of Open Access Journals
الوصف
تدمد:25900897
DOI:10.1016/j.urolvj.2023.100226