Background: Advances in the three dimensional (3D) reconstruction and printing technology have fueled a rapidly growing interest in its applications in the field of urology. To our knowledge, the experience on the use of 3D reconstruction to facilitate zero-ischemia partial nephrectomy (PN) remains sparse and the role of 3D reconstruction is still needed to be defined. This study aimed to assess the role of three-dimensional (3D) reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN).
Methods: A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiology findings were directly correlated with intraoperative surgical findings at laparoscopy. Demographics, perioperative characteristics and renal function were compared between groups.
Results: CTA and 3D reconstruction were successfully performed without any related complications. All the procedures were performed successfully without conversion to main renal artery clamping. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P>0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P<0.05). 3D reconstruction group resulted in more accurate dissection of tumor artery (91.7%) as compared to conventional CTA (84.2%). There were no statistical differences in the baseline characteristics and renal function outcomes between two groups.
Conclusions: 3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation that may facilitate tumor resection during zero-ischemia LPN for renal tumors.