Three-dimensional visualization techniques improve surgical Decision Making of robotic-assisted partial nephrectomy

Yuchao Wang; Qiliang Teng; Zhihong Dai; Chunyu Chen; Liren Zhang; Jiaxin Xie; Hao Wang; Zihan Xin; Sishan Chen; Yu Tai; Liang Wang; Bo Fan; Zhiyu Liu

doi:10.1016/j.heliyon.2024.e38806

Three-dimensional visualization techniques improve surgical Decision Making of robotic-assisted partial nephrectomy

Heliyon. 2024 Oct 9;10(21):e38806. doi: 10.1016/j.heliyon.2024.e38806. eCollection 2024 Nov 15.

Authors

Yuchao Wang^{1

2

3

4}, Qiliang Teng⁵, Zhihong Dai^{1

2

3

4}, Chunyu Chen^{1

2

3

4}, Liren Zhang⁶, Jiaxin Xie⁷, Hao Wang⁸, Zihan Xin⁸, Sishan Chen⁹, Yu Tai⁹, Liang Wang^{1

2

3

4}, Bo Fan^{1

2

3

4}, Zhiyu Liu^{1

2

3

4}

Affiliations

¹ Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning Province, China.
² Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, Dalian, 116011, Liaoning Province, China.
³ Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Dalian, 116011, Liaoning Province, China.
⁴ Dalian Key Laboratory of Prostate Cancer Research, Dalian, 116011, Liaoning Province, China.
⁵ Department of Urology, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, Guangdong Province, China.
⁶ The Third People's Hospital of Dalian, Dalian, 116011, Liaoning Province, China.
⁷ Institute of Urology, Peking University, Beijing, 100034, Beijing, China.
⁸ Department of Clinical Medicine, First Clinical School of Dalian Medical University, Dalian, 116044, Liaoning Province, China.
⁹ Department of Anesthesia, Dalian Medical University, Dalian, 116011, Liaoning Province, China.

Abstract

Background: Complete preoperative comprehension of the adjacent structures of the kidney and location of renal vessels is essential for robot-assisted partial nephrectomy (RAPN). The effectiveness of three-dimensional (3D) visualization techniques in improving perioperative outcomes of RAPN has been inconsistent and has not been reported in Northeastern China.

Methods: In this cohort study, we reviewed patients with renal tumours who underwent RAPN between April 2019 and April 2024. Three-dimensional visualization models were reconstructed to evaluate resectability parameters, including vascular variations, collection system infiltration, and lymphatic involvement. Subsequently, a meta-analysis combining previous studies utilising 3D visualization techniques for partial nephrectomy was conducted.

Results: Of the 324 patients in the cohort, 147 were preoperatively evaluated using the 3D technology. Group 3D had significantly less estimated blood loss (P < 0.001) and a shorter operative time (P = 0.016) than in group No 3D. We also found that the rates of intraoperative ultrasound use (P = 0.015), intraoperative complications (P = 0.007), intraoperative transfusions (P = 0.007), and postoperative Clavien complications (P < 0.001) in group 3D were significantly lower than in group No 3D. The above findings were consistent in the subgroup with R.E.N.A.L. ≥ 8 points partly. Furthermore, a meta-analysis identified 11 studies that included 1522 patients who underwent RAPN. Use of 3D visualization technology resulted in decreased 55 % risk of opening the collecting system (Risk Ratio [RR] = 0.45[0.22-0.92], P = 0.030) and 79 % incidence of conversion to radical nephrectomy (RR = 0.21[0.08-0.57], P = 0.002). The RAPN group assisted by 3D visualization techniques showed an 81 % reduction in the risk of blood transfusion than in the control group (RR = 0.19[0.08-0.44], P < 0.001).

Conclusions: The application of 3D technology in RAPN appears to be superior for improving precise tumour removal and reducing adverse perioperative outcomes and should be considered for wide use in clinical practice.

Keywords: Cohort studies; Kidney neoplasms; Meta-analysis; Nephrectomy; Three-dimensional.