Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy

Eur Urol. 2012 Jan;61(1):211-7. doi: 10.1016/j.eururo.2011.07.068. Epub 2011 Sep 15.

Abstract

Zero-ischemia robotic and laparoscopic partial nephrectomy, a novel concept, eliminates ischemia to the tumor-free normal kidney. Anatomic microdissection of tertiary/higher-order tumor-specific arteries is performed to selectively devascularize only the tumor, maintaining normal perfusion of the remaining kidney. A thorough understanding of renovascular tumor anatomy is essential. Based on 0.5-mm-slice thickness computed tomography scans, we developed a novel three-dimensional (3D) reconstruction technique that fuses three key anatomic aspects: surface-rendered tumor, semitransparent kidney, and extra- and intrarenal arterial anatomy. Four central completely intrarenal hilar masses underwent 3D reconstruction for surgical navigation during zero-ischemia partial nephrectomy. Negative surgical margins were obtained in all four cases, with no intraoperative complications or transfusions. For these challenging laparoscopically invisible masses, 3D image navigation precisely identified tumor-specific arterial branches, thus facilitating zero-ischemia partial nephrectomy without hilar cross clamping.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Imaging, Three-Dimensional*
  • Kidney Neoplasms / blood supply
  • Kidney Neoplasms / diagnostic imaging*
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / surgery*
  • Laparoscopy
  • Male
  • Microdissection
  • Middle Aged
  • Nephrectomy* / methods
  • Predictive Value of Tests
  • Radiographic Image Interpretation, Computer-Assisted*
  • Renal Artery / diagnostic imaging*
  • Renal Artery / surgery*
  • Robotics
  • Surgery, Computer-Assisted
  • Tomography, X-Ray Computed*
  • Treatment Outcome