Pd37-08 3d modeling of renal tumors for planning and guidance of selective clamping and ucs suture

You have accessJournal of UrologyCME1 May 2022PD37-08 3D MODELING OF RENAL TUMORS FOR PLANNING AND GUIDANCE OF SELECTIVE CLAMPING AND UCS SUTURE Riccardo Schiavina, Lorenzo Bianchi, Laura Cercenelli, Barbara Bortolani, Pietro Piazza, Sara Boschi, Matteo Droghetti, Angelo Mottaran, Francesco Costa, Francesco Chessa, Amelio Ercolino, Andrea Angiolini, Simone Lodi, Alessandro Pissavini, Luca Fontanella, Luca Spinozzi, Riccardo Melloni, Federico Bevilacqua, Danilo Cangemi, Caterina Gaudiano, Beniamino Corcioni, Rita Golfieri, Emanuala Marcelli, and Eugenio Brunocilla Riccardo SchiavinaRiccardo Schiavina More articles by this author , Lorenzo BianchiLorenzo Bianchi More articles by this author , Laura CercenelliLaura Cercenelli More articles by this author , Barbara BortolaniBarbara Bortolani More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Sara BoschiSara Boschi More articles by this author , Matteo DroghettiMatteo Droghetti More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Francesco CostaFrancesco Costa More articles by this author , Francesco ChessaFrancesco Chessa More articles by this author , Amelio ErcolinoAmelio Ercolino More articles by this author , Andrea AngioliniAndrea Angiolini More articles by this author , Simone LodiSimone Lodi More articles by this author , Alessandro PissaviniAlessandro Pissavini More articles by this author , Luca FontanellaLuca Fontanella More articles by this author , Luca SpinozziLuca Spinozzi More articles by this author , Riccardo MelloniRiccardo Melloni More articles by this author , Federico BevilacquaFederico Bevilacqua More articles by this author , Danilo CangemiDanilo Cangemi More articles by this author , Caterina GaudianoCaterina Gaudiano More articles by this author , Beniamino CorcioniBeniamino Corcioni More articles by this author , Rita GolfieriRita Golfieri More articles by this author , Emanuala MarcelliEmanuala Marcelli More articles by this author , and Eugenio BrunocillaEugenio Brunocilla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002595.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the impact of three-dimensional (3D) modeling of renal mass on surgical planning and intraoperative guidance of arterial clamping and urinary collecting system (UCS) suture during partial nephrectomy (PN), compared to conventional 2D imaging. METHODS: Overall, 195 patients with cT1-T2 renal cancer eligible for PN were prospectively enrolled. Each patient underwent chest and abdominal computer tomography (CT) before surgery performed at single tertiary center. Overall, 175 patients effectively underwent PN were included. Population was stratified in two groups: study group (n=91), in which a 3D renal model was obtained from CT images and reviewed by surgeons; control group (n=84) in which only 2D imaging of CT scan was reviewed by surgeons. Outcomes of interest were followings: preoperative plan of arterial clamping (off clamping, non-selective vs. selective clamping) and of UCS suture, intraoperative effective clamping approach and need of UCS suture. Chi-square, T-student and Mann-Whitney U-test were used to compare the two groups. Multivariate logistic analysis was performed to identify independent predictors of selective or super-selective clamping and need of UCS suture. RESULTS: The preoperative plan of arterial clamping was clampless, non-selective and selective in 36.9%, 54.8% and 8.3% of patients in control group vs. 24.2%, 24.2% and 51.6% of cases in study group, respectively (p <0.001). During surgery, clampless, non-selective and selective PN was performed in 36.9%, 53.6% and 9.5% in control group vs. 28.6%, 35.2% and 36.3% in study group, respectively (p <001). Indeed, the selective clamping was performed in 61.7% of cases as previously planned by 3D model in study group and in 28.6% of cases as previously planned by 2D imaging in control group (p <0.001). Preoperative UCS suture was planned in 50 (28.7%) patients with no difference between the two groups. However, the intraoperative UCS repair was performed in 7 (8.3%) patients of control group and in 21 (23.3%) patients of study group (p=0.007). At multivariate analysis, PADUA score (Odd Ratio [OR] 1.99), RENAL score (OR: 1.76) and the use of 3D model (OR 4.57) were independent predictors of UCS suturing (all p ≤0.004), while only the use of 3D model was found to be an independent predictor for selective clamping (OR 5.26, p <0.001). CONCLUSIONS: The 3D-guided approach for PN improves the surgical planning with more effective strategy, increase adoption of selective clamping and need of UCS suture, with higher rate of intraoperative management as previously planned. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e642 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Schiavina More articles by this author Lorenzo Bianchi More articles by this author Laura Cercenelli More articles by this author Barbara Bortolani More articles by this author Pietro Piazza More articles by this author Sara Boschi More articles by this author Matteo Droghetti More articles by this author Angelo Mottaran More articles by this author Francesco Costa More articles by this author Francesco Chessa More articles by this author Amelio Ercolino More articles by this author Andrea Angiolini More articles by this author Simone Lodi More articles by this author Alessandro Pissavini More articles by this author Luca Fontanella More articles by this author Luca Spinozzi More articles by this author Riccardo Melloni More articles by this author Federico Bevilacqua More articles by this author Danilo Cangemi More articles by this author Caterina Gaudiano More articles by this author Beniamino Corcioni More articles by this author Rita Golfieri More articles by this author Emanuala Marcelli More articles by this author Eugenio Brunocilla More articles by this author Expand All Advertisement PDF DownloadLoading ...