The influence of 3D renal reconstruction on surgical planning for complex renal tumors: An interactive case-based survey

Abstract

Objectives: To evaluate the role of three-dimensional (3D) reconstruction in preoperative planning for complex renal tumors.

Materials and methods: A well-planned questionnaire was distributed among the attending urologists at an international meeting. The questionnaire inquired about demographic data, surgical experience, partial nephrectomy (PN) versus radical nephrectomy (RN), surgical approach, time of ischemia, probability of postoperative urine leakage and positive surgical margins after viewing computed tomography (CT) scans and their respective 3D models of six complex renal tumors. Following the CT scans, attendees were asked to view randomly selected reconstructions of the cases.

Results: One hundred expert urologists participated in the study; 61% were aged between 40 and 60 years. Most of them (74%) were consultants. The overall likelihood of PN after viewing the 3D reconstructions significantly increased (7.1±2.7 vs. 8.0±2.2, p<0.001), the probability of conversion to RN significantly decreased (4.3±2.8 vs. 3.2±2.5, p<0.001), and the likelihood of urine leakage and positive surgical margins significantly decreased (p<0.001). Preference for the open approach significantly decreased (21.2% vs. 12.1%, p<0.001), while selective clamping techniques significantly increased (p<0.001). After viewing the 3D models, low expected warm ischemia time and estimated blood loss were significantly preferred by the respondents (p<0.001). Surgical decision change was significantly associated with performance or participation in more than 20 PNs or RNs annually [3.25 (1.98-5.22) and 2.87 (1.43-3.87), respectively].

Conclusions: 3D reconstruction models play a significant role in modifying surgeons' strategy and surgical planning for patients with renal tumors, especially for patients with stronger indications for a minimally invasive and/or nephron-sparing approach.

Keywords: Neoplasms; Nephrectomy; Surgical Procedures, Operative.

Figure 1. Representative CT scans and 3D reconstructions of the first three surveyed cases. Left, portovenous phase of a coronal/axial view CT scan. Middle, Colored CT scan image, red (artery/renal cortex), blue (vein), green (mass). Right, Model displayed in a web browser after reconstruction in 3D, red (artery), blue (vein), green (mass), purple (cyst), yellow (collecting system/ureter).

Figure 2. Representative CT scans and 3D reconstructions of the first three surveyed cases. Left, portovenous phase of a coronal/axial view CT scan. Middle, Colored CT scan image, red (artery/renal cortex), blue (vein), green (mass). Right, Model displayed in a web browser after reconstruction in 3D, red (artery), blue (vein), green (mass), purple (cyst), yellow (collecting system/ureter).