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| Hyper accuracy three-dimensional virtual anatomical rainbow model facilitates surgical planning and safe selective clamping during robot-assisted partial nephrectomy |
Francesco Ditonnoa,b,Antonio Francoa,c,Celeste Manfredia,d,Daniele Amparoree,Enrico Checcuccie,Marco De Siod,Alessandro Antonellib,Cosimo De Nunzioc,Cristian Fiorie,Francesco Porpigliae,Riccardo Autorinoa,*( )
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aDepartment of Urology, Rush University, Chicago, IL, USA
bDepartment of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
cDepartment of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
dUnit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
eDivision of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy |
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Abstract Objective: To highlight the role of hyper accuracy three-dimensional (3D) reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy (RAPN). Methods:A transperitoneal RAPN was performed in a 62-year-old male patient presenting with a 4 cm right anterior interpolar renal mass (R.E.N.A.L nephrometry score 7A). An abnormal vasculature was observed, with a single renal vein and two right renal arteries originating superiorly to the vein and anterior, when dividing in their segmental branches. According to the hyper accuracy 3D (HA3D®) rainbow model (MEDICS Srl, Turin, Italy), one branch belonging to one of the segmental arteries was feeding the tumor. This allowed for an accurate prediction of the area vascularized by each arterial branch. The 3D model was included in the intraoperative console view during the whole procedure, using the TilePro feature. A step-by-step explanation of the procedure is provided in the video attached to the present article. Results:The operative time was 90 min with a warm ischemia time on selective clamping of 13 min. Estimated blood loss was 180 mL. No intraoperative complication was encountered and no drain was placed at the end of the procedure. The patient was discharged on postoperative Day 2, without any early postoperative complications. The final pathology report showed a pathological tumor stage 1 clear cell renal cell carcinoma with negative surgical margins. Conclusion: The present study and the attached video illustrate the value of 3D rainbow model during the planning and execution of a RAPN with selective clamping. It shows how the surgeon can rely on this model to be more efficient by avoiding unnecessary surgical steps, and to safely adopt a “selective” clamping strategy that can translate in minimal functional impact.
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Received: 11 May 2023
Available online: 20 October 2024
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Corresponding Authors:
*E-mail address: ricautor@gmail.com (R. Autorino).
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Accurate reproduction of the kidney by the hyper accuracy three-dimensional (HA3D®) rainbow model (MEDICS Srl, Turin, Italy). (A) Renal anatomy; (B) Tumor vascularization.
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Trocar placement for right robot-assisted partial nephrectomy. Light blue: 8 mm trocars for robotic arms; green:8 mm trocar for 30-d-gree endoscope; yellow: 12 mm trocar for the assistant with the AirSeal® system (CONMED, Utica, NY, USA); dark blue: 5 mm trocar for liver retraction.
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Isolation of the elements of the renal pedicle. IVC, inferior vena cava.
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Devascularization of renal mass after selective clamping confirmed with injection of indocyanine green.
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