Application of the "four-quadrant" tumor target-artery positioning in retroperitoneal laparoscopic partial nephrectomy / 中华泌尿外科杂志

Objective To evaluate the safety,feasibility of the application of "four-quadrant" tumor target-artery positioning in "zero-ischemia" retroperitoneal laparoscopic partial nephrectomy.Methods A retrospective study was conducted on 25 patients who underwent retroperitoneal laparoscopic partial nephrectomy from November 2016 to March 2017 by single surgeon.There were 15 males and 10 females with a mean age of (52.6 ± 11.9) years old.The mean diameter of the tumor was (3.8 ± 0.5) cm.The mean R.E.N.A.L.score was (9.0±1.3).The mean GFR of the operation side was (49.2±11.4) ml/(min · 1.73 m2) before the operation.All 25 patients underwent 3 Dimentional CT for the reconstruction of their renal models.The tumor target-artery was located in "four-quadrant" system,which based on the boundary between tumor and renal parenchyma.Perioperative outcomes including the estimated blood loss (EBL),operation time,complications and oncological outcomes were carefully collected and analyzed.Results Of all the 25 patients,21 patients underwent "zero-ischemia" retroperitoneal laparoscopic partial nephrectomy,the mean operation time was (106.1 ± 18.8) min,the mean EBL was (162.2 ±68.0) ml with no transfusion case.4 patients converted to conventional retroperitoneal laparoscopic partial nephrectomy,the operation time was 110-140 min,the EBL was 350-500 ml and the warm-ischemia time was 12-20 min respectively.The pathological outcome shows renal cell carcinoma in 24 patients and papillary renal cell carcinoma in 1 patient with all negative margins.The mean GFR of the operation side was (45.1 ± 10.2) ml/(min · 1.73 m2) after three months of the surgery and shows no statistical difference (P =0.268).Conclusion The application of the "four-quadrant" tumor target-artery positioning in " zeroischemia" retroperitoneal laparoscopic partial nephrectomy is a safety and feasible method in terms of accurate location of the target-artery,better postoperative renal function,low EBL and reasonable oncological outcomes.

Retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic renal tumours / 中华泌尿外科杂志

Objective To evaluate the safety,efficiency of retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors,and summarize the surgical experience.Methods From Jan 2015 to Jan 2016,5 patients with completely endophytic tumors,who underwent retroperitoneal laparoscopic partial nephrectomy were recruited.one patient underwent 3D printing kidney model,and another 4 patients underwent 3Dimensional CT and locating four projection positions of the tumor on the surface,in order to guide the tumor resection in laparoscopic partial nephrectomy.Perioperative,operative,and postoperative,as well as oncological outcomes were analyzed.Results In all 5patients,preoperative four points location in 3D model or 3Dimensional CT for completely endophytic tumors is feasible and accurate in term of locating the tumor.The mean operative time was(129.0 ± 19.5) min,mean warm ischaemia time was (19.6 ± 5.4) min and mean estimated blood loss was(100 ± 83) ml.Pathological examination showed cell renal cell carcinoma.All the patients had a negative surgical margin,and no tumor recurrence or metastasis during 6-18months of follow up.Conclusions In experienced institutes,retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors is a feasible and safe procedure in terms of accurate locations,low complication rates,reasonable functional and oncologic outcomes after an intermediate-term follow-up

Intraorbital Encephalocele Presenting with Exophthalmos and Orbital Dystopia : CT and MRI Findings

A 15-year-old female patient with progressive pulsatile exophthalmos caused by intraorbital encephalocele was evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) in our clinic. She had no history of trauma or reconstructive surgery. When she was a little girl, she had undergone surgery for congenital glaucoma on the right eye. On the three-dimensional image of CT, a hypoplasic bone defect was observed in the greater wing of the right sphenoid bone. MRI and CT scan showed herniation through this defect of the arachnoid membrane and protruded cerebral tissue into the right orbita. Intraorbital encephalocele is an important entity that can cause pulsatile exophthalmos and blindness.

Comparison of personal computer with CT workstation in the evaluation of 3-dimensional CT image of the skull / 대한구강악안면방사선학회지

PURPOSE: To evaluate the usefulness of the reconstructed 3-dimensional image on the personal computer in comparison with that of the CT workstation by quantitative comparison and analysis. MATERIALS AND METHODS: The spiral CT data obtained from 27 persons were transferred from the CT workstation to a personal computer, and they were reconstructed as 3-dimensional image on the personal computer using V-works 2.0(TM). One observer obtained the 14 measurements on the reconstructed 3-dimensional image on both the CT workstation and the personal computer. Paired t test was used to evaluate the intraobserver difference and the mean value of the each measurement on the CT workstation and the personal computer. Pearson correlation analysis and % incongruence were also performed. RESULTS: I-Gn, N-Gn, N-A, N-Ns, B-A, and G-Op did not show any statistically significant difference (p>0.05), B-O, B-N, Eu-Eu, Zy-Zy, Biw, D-D, Orbrd R, and L had statistically significant difference (p<0.05), but the mean values of the differences of all measurements were below 2 mm, except for D-D. The value of correlation coefficient gamma was greater than 0.95 at I-Gn, N-Gn, N-A, N-Ns, B-A, B-N, G-Op, Eu-Eu, Zy-Zy, and Biw, and it was 0.75 at B-O, 0.78 at D-D, and 0.82 at both Orbrd R and L. The % incongruence was below 4% at I-Gn, N-Gn, N-A, N-Ns, B-A, B-N, G-Op, Eu-Eu, Zy-Zy, and Biw, and 7.18%, 10.78%, 4.97%, 5.89% at B-O, D-D, Orbrd R and L respectively. CONCLUSION: It can be considered that the utilization of the personal computer has great usefulness in reconstruction of the 3-dimensional image when it comes to the economics, accessibility and convenience, except for thin bones and the landmarks which are difficult to be located.