Deep Learning Plus Three-Dimensional Printing in the Management of Giant (>15 cm) Sporadic Renal Angiomyolipoma: An Initial Report

ObjectiveTo evaluate the feasibility and effectivity of deep learning (DL) plus three-dimensional (3D) printing in the management of giant sporadic renal angiomyolipoma (RAML).MethodsThe medical records of patients with giant (>15 cm) RAML were retrospectively reviewed from January 2011 to December 2020. 3D visualized and printed kidney models were performed by DL algorithms and 3D printing technology, respectively. Patient demographics and intra- and postoperative outcomes were compared between those with 3D-assisted surgery (3D group) or routine ones (control group).ResultsAmong 372 sporadic RAML patients, 31 with giant ones were eligible for analysis. The median age was 40.6 (18–70) years old, and the median tumor size was 18.2 (15–28) cm. Seventeen of 31 (54.8%) had a surgical kidney removal. Overall, 11 underwent 3D-assisted surgeries and 20 underwent routine ones. A significant higher success rate of partial nephrectomy (PN) was noted in the 3D group (72.7% vs. 30.0%). Patients in the 3D group presented a lower reduction in renal function but experienced a longer operation time, a greater estimated blood loss, and a higher postoperative morbidity. Subgroup analysis was conducted between patients undergoing PN with or without 3D assistance. Despite no significant difference, patients with 3D-assisted PN had a slightly larger tumor size and higher nephrectomy score, possibly contributing to a relatively higher rate of complications. However, 3D-assisted PN lead to a shorter warm ischemia time and a lower renal function loss without significant difference. Another subgroup analysis between patients under 3D-assisted PN or 3D-assisted RN showed no statistically significant difference. However, the nearness of tumor to the second branch of renal artery was relatively shorter in 3D-assisted PN subgroup than that in 3D-assisted RN subgroup, and the difference between them was close to significant.Conclusions3D visualized and printed kidney models appear to be additional tools to assist operational management and avoid a high rate of kidney removal for giant sporadic RAMLs.

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Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1403-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Yuan-Wei Zhang ◽

Xin Xiao ◽

Wen-Cheng Gao ◽

Yan Xiao ◽

Su-Li Zhang ◽

...

Keyword(s):

3D Printing ◽

Blood Loss ◽

Three Dimensional ◽

Operation Time ◽

Varus Deformity ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Cubitus Varus ◽

Guide Plate ◽

Significant Difference

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.

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Traditional versus mirror three-dimensional printing technology for isolated acetabular fractures: a retrospective study with a median follow-up of 25 months

Journal of International Medical Research ◽

10.1177/03000605211028554 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110285

Author(s):

Kai Xiao ◽

Bo Xu ◽

Lin Ding ◽

Weiguang Yu ◽

Lei Bao ◽

...

Keyword(s):

3D Printing ◽

Three Dimensional ◽

Operation Time ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Printing Technology ◽

Three Dimensional Printing ◽

3D Printing Technology ◽

Significant Difference

Objective To assess the outcomes of traditional three-dimensional (3D) printing technology (TPT) versus mirror 3D printing technology (MTT) in treating isolated acetabular fractures (IAFs). Methods Consecutive patients with an IAF treated by either TPT or MTT at our tertiary medical centre from 2012 to 2018 were retrospectively reviewed. Follow-up was performed 1, 3, 6, and 12 months postoperatively and annually thereafter. The primary outcome was the Harris hip score (HHS), and the secondary outcomes were major intraoperative variables and key orthopaedic complications. Results One hundred fourteen eligible patients (114 hips) with an IAF (TPT, n = 56; MTT, n = 58) were evaluated. The median follow-up was 25 months (range, 21–28 months). At the last follow-up, the mean HHS was 82.46 ±14.70 for TPT and 86.30 ± 13.26 for MTT with a statistically significant difference. Significant differences were also detected in the major intraoperative variables (operation time, intraoperative blood loss, number of fluoroscopic screenings, and anatomical reduction number) and the major orthopaedic complications (loosening, implant failure, and heterotopic ossification). Conclusion Compared with TPT, MTT tends to produce accurate IAF reduction and may result in better intraoperative variables and a lower rate of major orthopaedic complications.

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Investigation of three-dimensional printing materials for printing aorta model replicating Type B aortic dissection

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210218102046 ◽

2021 ◽

Vol 17 ◽

Author(s):

Chia-An Wu ◽

Andrew Squelch ◽

Zhonghua Sun

Keyword(s):

3D Printing ◽

Aortic Dissection ◽

Three Dimensional ◽

Ct Images ◽

Patient Specific ◽

Type B ◽

Type B Aortic Dissection ◽

Ct Attenuation ◽

Significant Difference ◽

3D Printed

Aim: To determine a printing material that has both elastic property and radiology equivalence close to real aorta for simulation of endovascular stent graft repair of aortic dissection. Background: With the rapid development of three-dimensional (3D) printing technology, a patient-specific 3D printed model is able to help surgeons to make better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic computed tomography (CT) attenuation. Objective: Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection. Method: A 25-mm length of aorta model was segmented from a patient’s image dataset with diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and conducted CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen.Five reference points with region of interest (ROI) of 1.77 mm2 were selected at the aortic wall and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient’s aorta and models was performed through a paired-sample t-test to determine if there is any significant difference. Result: The mean CT attenuation of aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with other three materials was significantly lower than that of original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images with statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05). Conclusion: Both Visijet CE-NT and Agilus have tensile strength and elongation close to real patient’s tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to lack of body phantom in the experiments, further research with simulation of realistic anatomical body environment should be conducted.

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Retrospective accuracy analysis of MRI based lesion size measurement in neuroblastic tumors: which sequence should we choose?

BMC Medical Imaging ◽

10.1186/s12880-020-00503-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sebastian Gassenmaier ◽

Ilias Tsiflikas ◽

Simon Maennlin ◽

Cristian Urla ◽

Steven W. Warmann ◽

...

Keyword(s):

Mr Imaging ◽

Tumor Size ◽

Three Dimensional ◽

Lesion Size ◽

Three Dimensions ◽

Neuroblastic Tumor ◽

Significant Difference ◽

Dimensional Measurements ◽

Neuroblastic Tumors ◽

Mri Measurements

Abstract Background MR imaging of neuroblastic tumors is widely used for assessing the effect of chemotherapy on tumor size. However, there are some concerns that MRI might falsely estimate lesion diameters due to calcification and fibrosis. Therefore, the aim of our study was to compare neuroblastic tumor size based on MRI measurements to histopathology measurements of the resected specimens as standard of reference. Methods Inclusion criteria were diagnosis of a neuroblastic tumor, MR imaging within 100 days to surgery and gross total resection without fragmentation of the tumor between 2008 and 2019. Lesion diameters were measured by two radiologists according to RECIST 1.1 in axial plane in T2w turbo spin echo (TSE), diffusion-weighted imaging (DWI), and in T1w pre- and postcontrast sequences. Furthermore, the largest lesion size in three-dimensions was noted. The largest diameter of histopathology measurements of each specimen was used for comparison with MRI. Results Thirty-seven patients (mean age: 5 ± 4 years) with 38 lesions (neuroblastoma: n = 17; ganglioneuroblastoma: n = 11; ganglioneuroma: n = 10) were included in this retrospective study. There was excellent intra-class correlation coefficient between both readers for all sequences (> 0.9) Tumor dimensions of reader 1 based on axial MRI measurements were significantly smaller with the following median differences (cm): T1w precontrast − 1.4 (interquartile range (IQR): 1.8), T1w postcontrast − 1.0 (IQR: 1.9), T2w TSE: -1.0 (IQR: 1.6), and DWI -1.3 (IQR: 2.2) (p < 0.001 for all sequences). However, the evaluation revealed no significant differences between the three-dimensional measurements and histopathology measurements of the resected specimens regardless of the applied MRI sequence. Conclusions Axial MRI based lesion size measurements are significantly smaller than histopathological measurements. However, there was no significant difference between three-dimensional measurements and histopathology measurements of the resected specimens. T2w TSE and T1w postcontrast images provided the lowest deviation and might consequently be preferred for measurements.

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Renal function, complications, and outcomes of a reduction in tumor size after transarterial embolization for renal angiomyolipomas: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060519834447 ◽

2019 ◽

Vol 47 (4) ◽

pp. 1417-1428

Author(s):

Letao Lin ◽

Xinfei Li ◽

Haitao Guan ◽

Jian Wang ◽

Xiaoqiang Tong ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Tumor Size ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Meta Analysis ◽

Transarterial Embolization ◽

Nitrogen Levels ◽

Significant Difference

Objective The present study aimed to evaluate renal function, complications, and changes in tumor size after transarterial embolization for patients with renal angiomyolipomas. Methods We performed a meta-analysis of transarterial embolization in patients with renal angiomyolipomas from January 1994 to April 2018. Endpoints of interest were the estimated glomerular filtration rate, serum creatinine levels, blood urea nitrogen levels, complications, and reduction of tumors. Results A total of 30 studies comprising 653 patients were included. A total of 32.0% of patients were treated by urgent transarterial embolization for spontaneous ruptured renal angiomyolipomas. Other patients sought to relieve symptoms or received embolism prophylactically. The estimated glomerular filtration rate showed no significant difference between before and after embolization. In 363 patients with data on complications, post-embolization syndrome occurred most frequently (54.0%). Only 16 (4.4%) patients had major complications. The diameter of sporadic angiomyolipomas was reduced by a mean of 2.09 cm (95% confidence interval [CI], 0.73–3.45 cm; I2 = 29.3%) and they were reduced in size by 30.0% (95% CI, 16.0%–44.0%; I2 = 27.9%). Conclusions Transarterial embolization of renal angiomyolipomas affects renal function preservation, with a low complication rate. Transarterial embolization is useful for sporadic and tuberous sclerosis complex-related angiomyolipomas.

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Retrospective Accuracy Analysis of MRI Based Lesion Size Measurement in Neuroblastic Tumors: Which Sequence Should We Choose?

10.21203/rs.3.rs-48644/v1 ◽

2020 ◽

Author(s):

Sebastian Gassenmaier ◽

Ilias Tsiflikas ◽

Simon Maennlin ◽

Cristian Urla ◽

Steven W. Warmann ◽

...

Keyword(s):

Mr Imaging ◽

Tumor Size ◽

Spin Echo ◽

Three Dimensional ◽

Lesion Size ◽

Three Dimensions ◽

Neuroblastic Tumor ◽

Significant Difference ◽

Dimensional Measurements ◽

Neuroblastic Tumors

Abstract Background: MR imaging of neuroblastic tumors is widely used for assessing the effect of chemotherapy on tumor size. However, there are some concerns that MRI might falsely estimate lesion diameters due to calcification and fibrosis.Therefore, the aim of our study was to compare neuroblastic tumor size based on MRI measurements to histopathology as standard of reference.Methods: Inclusion criteria were diagnosis of a neuroblastic tumor, MR imaging within 100 days to surgery and gross total resection without fragmentation of the tumor between 2008-2019. Lesion diameters were measured by two radiologists according to RECIST 1.1 in axial plane in T2w turbo spin echo (TSE), diffusion-weighted imaging (DWI) and in T1w pre- and postcontrast sequences. Furthermore, the largest lesion size in three-dimensions was noted. The largest diameter of histopathology measurements was used for comparison with MRI.Results: Thirty-seven patients (mean age: 5±4 years) with 38 lesions (neuroblastoma: n=17; ganglioneuroblastoma: n=11; ganglioneuroma: n=10) were included in this retrospective study. There was excellent intra-class correlation coefficient between both readers for all sequences(>0.9)Tumor dimensions of reader 1 based on axial MRImeasurements were significantly smaller with the following median differences (cm): T1w precontrast-1.4 (interquartile range (IQR): 1.8 ), T1w postcontrast -1.0 (IQR: 1.9),T2w TSE:-1.0 (IQR: 1.6) and DWI -1.3 (IQR: 2.2) (p<0.001 for all sequences). However, the evaluation revealed no significant differences between the three-dimensional measurements and histopathology regardless of the applied MRI sequence.Conclusions: Axial MRI based lesion size measurementsare significantly smaller than histopathological measurements. However, there was no significant difference between three-dimensional measurements and histopathology. T2w TSE and T1w postcontrast images provided the lowest deviation and might consequently be preferred for measurements.

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Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Journal of Neurosurgery Spine ◽

10.3171/2014.12.spine14545 ◽

2015 ◽

Vol 23 (3) ◽

pp. 280-289 ◽

Cited By ~ 35

Author(s):

Darryl Lau ◽

Dean Chou ◽

Praveen V. Mummaneni

Keyword(s):

Length Of Stay ◽

Neck Pain ◽

Cobb Angle ◽

Clinical Outcomes ◽

Subgroup Analysis ◽

Cervical Spondylotic Myelopathy ◽

Complication Rates ◽

Second Stage ◽

Estimated Blood Loss ◽

Significant Difference

OBJECT In the treatment of cervical spondylotic myelopathy (CSM), anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) are effective decompressive techniques. It remains to be determined whether ACCF and ACDF offer equivalent outcomes for multilevel CSM. In this study, the authors compared perioperative, radiographic, and clinical outcomes between 2-level ACCF and 3-level ACDF. METHODS Between 2006 and 2012, all patients at the authors' hospital who underwent 2-level ACCF or 3-level ACDF performed by 1 of 2 surgeons were identified. Primary outcomes of interest were sagittal Cobb angle, adjacent-segment disease (ASD) requiring surgery, neck pain measured by visual analog scale (VAS), and Nurick score. Secondary outcomes of interest included estimated blood loss (EBL), length of stay, perioperative complications, and radiographic pseudarthrosis rate. Chi-square tests and 2-tailed Student t-tests were used to compare the 2 groups. A subgroup analysis of patients without posterior spinal fusion (PSF) was also performed. RESULTS Twenty patients underwent 2-level ACCF, and 35 patients underwent 3-level ACDF during a 6-year period. Preoperative Nurick scores were higher in the ACCF group (2.1 vs 1.1, p = 0.014), and more patients underwent PSF in the 2-level ACCF group compared with patients in the 3-level ACDF group (60.0% vs 17.1%, p = 0.001). Otherwise there were no significant differences in demographics, comorbidities, and baseline clinical parameters between the 2 groups. Two-level ACCF was associated with significantly higher EBL compared with 3-level ACDF for the anterior stage of surgery (382.2 ml vs 117.9 ml, p < 0.001). Two-level ACCF was also associated with a longer hospital stay compared with 3-level ACDF (7.2 days vs 4.9 days, p = 0.048), but a subgroup comparison of patients without PSF showed no significant difference in length of stay (3.1 days vs 4.4 days for 2-level ACCF vs 3-level ACDF, respectively; p = 0.267). Similarly, there was a trend toward more complications in the 2-level ACCF group (20.0%) than the 3-level ACDF group (5.7%; p = 0.102), but a subgroup analysis that excluded those who had second-stage PSF no longer showed the same trend (2-level ACCF, 0.0% vs 3-level ACDF, 3.4%; p = 0.594). There were no significant differences between the ACCF group and the ACDF group in terms of postoperative sagittal Cobb angle (7.2° vs 12.1°, p = 0.173), operative ASD (6.3% vs 3.6%, p = 0.682), and radiographic pseudarthrosis rate (6.3% vs 7.1%, p = 0.909). Both groups had similar improvement in mean VAS neck pain scores (3.4 vs 3.2 for ACCF vs ACDF, respectively; p = 0.860) and Nurick scores (0.8 vs 0.7, p = 0.925). CONCLUSIONS Two-level ACCF was associated with greater EBL and longer hospital stays when patients underwent a second-stage PSF. However, the length of stay was similar when patients underwent anterior-only decompression with either 2-level ACCF or 3-level ACDF. Furthermore, perioperative complication rates were similar in the 2 groups when patients underwent anterior decompression without PSF. Both groups obtained similar postoperative cervical lordosis, operative ASD rates, radiographic pseudarthrosis rates, neurological improvement, and pain relief.

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Deep learning-based automatic delineation of the hippocampus by MRI: geometric and dosimetric evaluation

Radiation Oncology ◽

10.1186/s13014-020-01724-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kaicheng Pan ◽

Lei Zhao ◽

Song Gu ◽

Yi Tang ◽

Jiahao Wang ◽

...

Keyword(s):

Deep Learning ◽

Learning Algorithm ◽

Positive Impact ◽

Three Dimensional ◽

Whole Brain Radiotherapy ◽

Work Load ◽

Dice Similarity Coefficient ◽

Target Area ◽

Slice Thickness ◽

Significant Difference

Abstract Background Whole brain radiotherapy (WBRT) can impair patients’ cognitive function. Hippocampal avoidance during WBRT can potentially prevent this side effect. However, manually delineating the target area is time-consuming and difficult. Here, we proposed a credible approach of automatic hippocampal delineation based on convolutional neural networks. Methods Referring to the hippocampus contouring atlas proposed by RTOG 0933, we manually delineated (MD) the hippocampus on the MRI data sets (3-dimensional T1-weighted with slice thickness of 1 mm, n = 175), which were used to construct a three-dimensional convolutional neural network aiming for the hippocampus automatic delineation (AD). The performance of this AD tool was tested on three cohorts: (a) 3D T1 MRI with 1-mm slice thickness (n = 30); (b) non-3D T1-weighted MRI with 3-mm slice thickness (n = 19); (c) non-3D T1-weighted MRI with 1-mm slice thickness (n = 11). All MRIs confirmed with normal hippocampus has not been violated by any disease. Virtual radiation plans were created for AD and MD hippocampi in cohort c to evaluate the clinical feasibility of the artificial intelligence approach. Statistical analyses were performed using SPSS version 23. P < 0.05 was considered significant. Results The Dice similarity coefficient (DSC) and Average Hausdorff Distance (AVD) between the AD and MD hippocampi are 0.86 ± 0.028 and 0.18 ± 0.050 cm in cohort a, 0.76 ± 0.035 and 0.31 ± 0.064 cm in cohort b, 0.80 ± 0.015 and 0.24 ± 0.021 cm in cohort c, respectively. The DSC and AVD in cohort a were better than those in cohorts b and c (P < 0.01). There is no significant difference between the radiotherapy plans generated using the AD and MD hippocampi. Conclusion The AD of the hippocampus based on a deep learning algorithm showed satisfying results, which could have a positive impact on improving delineation accuracy and reducing work load.

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Three-dimensional printing technology for localised thoracoscopic segmental resection for lung cancer

10.21203/rs.3.rs-19927/v1 ◽

2020 ◽

Author(s):

Yangming Chen ◽

Jiguang Zhang ◽

Qianshun Chen ◽

Tian Li ◽

Kai Chen ◽

...

Keyword(s):

3D Printing ◽

Operative Time ◽

Three Dimensional ◽

Ct Reconstruction ◽

Printing Technology ◽

3D Printing Technology ◽

Significant Difference ◽

Group A ◽

Group B ◽

Ground Glass Nodules

Abstract Background Three-dimensional (3D) CT reconstruction technology has gained increasing attention owing to its potential in locating ground glass nodules in the lung. The 3D printing technology additionally allows visualising the surrounding anatomical structure and variations. However, the clinical utility of these techniques is not known. We aimed to establish a lung tumour and an anatomical lung model using three-dimensional (3D) printing and 3D chest computed tomography (CT) reconstruction and to evaluate the clinical potential of 3D printing technology in uniportal video-assisted thoracoscopic segmentectomy. Methods Eighty-nine patients with ground glass nodules who underwent uniportal video-assisted thoracoscopic segmentectomy were divided into the following groups: Group A, lung models for pre-positioning and simulated surgery that were made with 3D chest CT reconstruction and 3D printing; Group B, patients who underwent chest CT scans with image enhancement for 3D reconstruction. The differences in the surgery approach transfer rate, surgical method conversion rate, operative time, intraoperative blood loss, and postoperative complication rate were compared between the groups. Results The surgery approach transfer rate was 0% and 10.5% for Groups A and B, respectively, showing a significant difference (p = 0.030). The operative time was 2.07 ± 0.24 hours and 2.55 ± 0.41 hours, respectively, showing a significant difference (p<༜0.001). Intraoperative blood loss volume was 43.25 ± 13.63 and 96.68 ± 32.82 ml, respectively, showing a significant difference (p<༜0.001). The postoperative complication rate was 3.9% and 13.2%, respectively, showing a non-significant difference (P = 0.132). The rate of surgical method conversion to lobectomy in Group A was 0%, which was significantly lower than that of 10.5% in group B (p < 0.030). Conclusions 3D printing technology helps surgeons to locate the nodules more accurately, as it is based on 2D and 3D imaging findings, thereby improving the accuracy and safety of surgery. This technique is worth for application in clinical practice. Trial registration: Retrospectively registered.

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Running suture hemostatic technique versus standard reconstruction of the surgical bed in Zero - Ischemia Time mini-flank Open Partial Nephrectomies. Retrospective, Match-Paired Case-Control Study

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.2.69 ◽

2019 ◽

Vol 91 (2) ◽

Author(s):

Petar Kavaric ◽

Aleksandar Magdelinic ◽

Marko Vukovic

Keyword(s):

Blood Loss ◽

Tumor Size ◽

Operative Time ◽

Surgical Techniques ◽

Control Group ◽

Reconstruction Technique ◽

Ischemia Time ◽

Estimated Blood Loss ◽

Significant Difference ◽

Zero Ischemia

Objective: To estimate the efficacy of our technique of zero ischemia time partial nephrectomy (ZTPN) with hemostatic running suture and compare it to the standard technique, in terms of perioperative complications, operative time (OT) and estimated blood loss (EBL). Materials and methods: We retrospectively analysed 180 consecutive patients who underwent ZTPN using a supra 11th or supra 12th rib mini flank approach. First group numbered 90 patients treated with running suture hemostatic technique (RSHT), while the control group enrolled 90 patients in whom we performed standard reconstruction technique (SRT). According the propensity score, both groups were similar in terms of tumor size, age and PADUA score. Patients with solitary tumour limited to the kidney (T1-T2a) were included. Our technique included a running suture of surgical bed edges and closure of the renal cortex by the positioning of peri-renal fat within the cortical bed and fixation with interrupted sutures. Results: PADUA score and tumor size were comparable between groups (7.12 ± 1.33 vs 7.1 ± 2.11, p = 0.4 and 52.9 ± 14.8 vs 50.0 ± 13.2, p = 0.3). The mean operative time (OT) was significantly longer in first group (165.2 vs 95, p = 0.04), while median estimated blood loss (EBL) was significantly reduced (250 vs 460 ml, p = 0.02). Surgical resection margins were negative in 100% of cases and no patient developed a local or distant recurrence during follow up. There was significant difference in postoperative GFR value between groups (p < 0.05). Conclusions: Our technique could be safely performed in local, low volume facilities, thus reducing the need for expensive and more challenging minimal invasive surgical techniques..

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