Interactive virtual 3D image reconstruction to assist renal surgery in patients with fusion anomalies of the kidney

Objective: Renal fusion anomalies are rare and usually present as horseshoe kidneys or crossed fusion ectopia. The complex renal anatomy seen in patients with these anomalies can present a challenge. Pre-operative planning is therefore paramount in the surgical management of these cases. Herein we report the use of interactive virtual three-dimensional (3D) reconstruction to aid renal surgery in patients with fusion anomalies of the kidney. Materials and Methods: A total of seven cases were performed between May 2016 and October 2020. 3D reconstruction was rendered by Innersight Labs using pre-operative computed tomography (CT) scans. Results: Five patients had malignant disease and two patients had benign pathology. Robotic and open operations were performed in four and three patients, respectively. Conclusion: The use of 3D reconstruction in the cases reported in this series allowed for the identification of variations in renal vasculature, and this informed the choice of operative approach. Oxford Centre for Evidence-Based Medicine Evidence Level: 4

Automatic Segmentation of Kidneys and Kidney Tumors: The KiTS19 International Challenge

Purpose: Clinicians rely on imaging features to calculate complexity of renal masses based on validated scoring systems. These scoring methods are labor-intensive and are subjected to interobserver variability. Artificial intelligence has been increasingly utilized by the medical community to solve such issues. However, developing reliable algorithms is usually time-consuming and costly. We created an international community-driven competition (KiTS19) to develop and identify the best system for automatic segmentation of kidneys and kidney tumors in contrast CT and report the results.Methods: A training and test set of CT scans that was manually annotated by trained individuals were generated from consecutive patients undergoing renal surgery for whom demographic, clinical and outcome data were available. The KiTS19 Challenge was a machine learning competition hosted on grand-challenge.org in conjunction with an international conference. Teams were given 3 months to develop their algorithm using a full-annotated training set of images and an unannotated test set was released for 2 weeks from which average Sørensen-Dice coefficient between kidney and tumor regions were calculated across all 90 test cases.Results: There were 100 valid submissions that were based on deep neural networks but there were differences in pre-processing strategies, architectural details, and training procedures. The winning team scored a 0.974 kidney Dice and a 0.851 tumor Dice resulting in 0.912 composite score. Automatic segmentation of the kidney by the participating teams performed comparably to expert manual segmentation but was less reliable when segmenting the tumor.Conclusion: Rapid advancement in automated semantic segmentation of kidney lesions is possible with relatively high accuracy when the data is released publicly, and participation is incentivized. We hope that our findings will encourage further research that would enable the potential of adopting AI into the medical field.

Evaluation of Analgesia Effect after Ultrasound-Guided Laparoscopic Renal Surgery

Kidney surgery involves placing the kidney in the iliac fossa of the lower abdomen on the right or left side. Studies have found that most kidney patients experience moderate to severe pain after surgery. The stress response caused by postoperative pain, especially visceral pain, not only aggravates the patient’s pain and irritability and aggravates the original complications but may also harm the early recovery of renal function and affect the survival of the kidney. Therefore, adequate postoperative analgesia for renal patients is essential. This paper combines ultrasound-guided laparoscopic technology to improve the postoperative analgesia effect of renal surgery and compares the data with experimental research methods. Through experimental research, it can be seen that the method proposed in this article has a certain effect, and ultrasound-guided laparoscopic technology can be used in follow-up clinical research to improve the analgesic effect of renal surgery.

A Comprehensive Analysis of Renal Cell Carcinoma as First and Second Primary Cancers

Objective Second primary renal cell carcinoma (2nd RCC) refers to renal cell carcinoma (RCC) diagnosed after another unrelated malignancy. This study aims Tto compare the clinical manifestation, pathology, treatment, and prognostic features of patients with second primary renal cell carcinoma (2nd RCC) and first primary renal cell carcinoma (1st RCC). Materials and Methods Data of the Ppatients with localized RCC were retrospectively collected. They were classified as 2nd RCC or 1st RCC according to a previously diagnosed cancer, including 113 cases of 2nd RCC and 749 cases of 1st RCC. ResultsThe most common types of extrarenal malignancies in patients with 2nd RCC include lung, colorectal, breast, gynecological, and gastric cancers. The age and smoking rate of 2nd RCC patients were significantly higher than in those of 1st RCC patients. For 2nd RCC patients, fFewer 2nd RCC patients had clinical symptoms and a large renal masses tend to be smaller. One hundred and eight (95.6%) patients with 2nd RCC received surgical interventions. All patients with 1st RCC underwent renal surgery. More patients with 2nd RCC underwent a partial nephrectomy. Pathologically, there was no significant difference in postoperative pathological types between the 2nd and 1st RCCs. However, the 2nd RCCs commonly occurred inhad the early stages. The median overall survival (OS) of 2nd RCC patients was 117 months, which was shorter than that of 1st RCC patients. ConclusionsPatients with 2ndSecond RCC are not uncommon. More attention should be paid to screening for 2nd RCC in cancer survivors. There are some differences between patients with 2nd and 1st RCCs that should be viewed separately.

Nephrectomy in Patient of Chronic Pyelonephritis with Non Functioning Kidney on Left Side: A Case Report

Introduction: There are two types of renal surgery i.e. partial nephrectomy and one other is total nephrectomy. Mostly, nephrostomy performs in malignant tumors of the renal. Sometimes it performs in kidney injury due to that no longer function and it may create any obstructive disorder in the renal system. Patient Information: A 45-year-old male patient presented with complaints of pain in the abdomen since 4 months. The patient was advised to ultrasonography abdomen and pelvis. Contrast-enhanced computed tomography (CE-CT) abdomen and pelvis were done. Previous treatment was undergone left-sided PCN for gross hydronephrosis of the left kidney. But after 4 months patient developed abdomen pain which was insidious in onset and progressive in nature. The pain was dull aching, in the left loin region, radiating to the back and intermittent. There are no aggravating or relieving factors associated with it and the patient is now referred to our hospital for further management patient was admitted to the male surgical ward. After the surgery planed left simple nephrectomy. Post-operative medication given, Inj. Revotaz (Piperacillin and tazobactam) 4.45 gm, Inj. Nirmet (Metronidazole) 100 ml, Inj Pantomay (Pantoprazole) 40 mg, Inj. Setron (Ondansetron) 4 mg, Inj tramadex (Tramadol hydrochloride) 100 mg, Inj temfix IV (Paracetamol) 100 ml. Discussion: Nephrectomy is one of the urologists conducting the most common ablative surgery. A non-functional kidney or an irreversibly impaired kidney is the commonest sign for a nephrectomy. Chronic infection, obstruction, calculus disease and serious traumatic injury are other typical indications for nephrectomy. Conclusion: In this case, the patient was on a closed monitor. To accomplish overall the situation during the time of surgery. Over all the patient response was positive for conservative and nursing management and after treatment the patient was discharged without any postoperative complications and satisfaction with full recovery.