Application of Three-Dimensional Visualization Technology in Laparoscopic Partial Nephrectomy of Renal Tumor: A Comparative Study

Purpose: To compare the effectiveness and safety of individualized three-dimensional visualization technology (3DVT) on surgical planning and perioperative outcomes in laparoscopic partial nephrectomy (LPN) for renal cell carcinoma (RCC) with routine computed tomography (CT) examination in the treatment of renal tumor.Methods: From May 2015 to March 2016, a total of 94 patients with cT1 RCC who underwent surgical treatment in our department were analyzed retrospectively. Among these patients, a total of 49 cases received LPN with operation plan based on 3DVT. Surgical plan was obtained by virtual operation and morphometry on 3D reconstruction model. The remaining 45 cases received surgical treatment with traditional CT examination. Patient demographic, surgical outcome, and postoperative parameters were compared between these two groups.Results: No significant difference was found in blood loss volume, postoperative complication, selective clamping success rate, changes in postoperative renal function, and operative and ischemic time between the two groups. However, when handling complicated tumor with R.E.N.A.L score >= 8, operation time (126.7 +/- 36.4 versus 154.8 +/- 34.7, P=.018) and occurrence of postoperative urinary leak (0 versus 4, 0% versus 22.2%, P=.033) were diminished significantly in the 3DVT group.Conclusions: 3DVT provided precise information of anatomical structure in the operative area and reliable guidance for preoperative plan design. Our results indicated that 3DVT facilitated accurate visible image-guided tumor resection with ideal renal function preservation in LPN for renal tumor of high complexity.

目的：比较个体化三维可视化技术（3DVT）与常规计算机断层扫描（CT）检查在肾肿瘤治疗中对肾细胞癌（RCC）腹腔镜肾部分切除术（LPN）的手术规划及围手术期结果的有效性和安全性。 方法：回顾性分析2015年5月至2016年3月在我科接受手术治疗的94例cT1期肾细胞癌患者。其中49例患者基于3DVT制定手术方案并接受LPN，通过对三维重建模型进行虚拟手术和形态测量来制定手术方案。其余45例患者采用传统CT检查进行手术治疗。比较两组患者的人口统计学资料、手术结果及术后参数。 结果：两组在出血量、术后并发症、选择性阻断成功率、术后肾功能变化以及手术时间和热缺血时间方面无显著差异。然而，在处理R.E.N.A.L评分≥8的复杂肿瘤时，3DVT组的手术时间（126.7±36.4对比154.8±34.7，P = 0.018）和术后尿漏发生率（0对比4，0%对比22.2%，P = 0.033）显著降低。 结论：3DVT为手术区域的解剖结构提供了精确信息，并为术前方案设计提供了可靠指导。我们的研究结果表明，3DVT有助于在高复杂性肾肿瘤的LPN中实现精确的可视化图像引导下的肿瘤切除，并理想地保留肾功能。