Application of 3D image reconstruction in robotic urological surgery / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the clinical value of three-dimensiomal (3D) image reconstruction in the urologic robot-assisted laparoscopic surgery.Methods From Sept.2017 to Jun.2018,7 patients (3 male cases,4 female cases) diagnosed with genitourinary tumors in Beijing United Family Hospital were involved in this study.The median age was 55 years(IQR 36-64 years).There were 1 case of renal tumor,1 case of adrenal gland tumor,1 case of retroperitoneal tumor,1 case of metastatic tumor post-nephrectomy,1 case of bladder neuroendocrine tumor and 1 case of urachal tumor.All the patients underwent four-phase enhanced CT scan and the CT images were imported into 3D visualization system for 3D image reconstruction,aiming to assist surgery planning and tumor locating.The main parameters of 3D image reconstruction included tumor size,location and the relationships among tumor,organs and blood vessels.All the 7 patients underwent robot-assisted laparoscopic surgeries,including 2 cases of partial nephrectomy (1 case with no blockage of renal artery),1 case of excision of right adrenal gland tumor,1 case of transperitoneal excision of left renal hilus chromaffinoma,1 case of transperitoneal excision of right adrenal gland and postcaval metastatic tumors,1 case of transperitoneal radical cystectomy + orthotopic bladder substitution + extended pelvic lymph node dissection,1 case of transperitoneal excision of urachal tumor + partial cystectomy + pelvic lymph node dissection.Results 3D image reconstruction svstem allows accurate evaluation of tumors,related vessels,surrounding tissue and organs before operation.All the 7 cases surgeries were uneventful,no case was converted to open or conventional laparoscopic surgery,the median operation time was 225 min (IQR 135-280 min),the median blood loss was 50 ml (IQR 20-600 ml).One patient had fever post-operation and there was no over Clavien Dindo Ⅱ perioperative complication.Conclusions 3D image reconstruction shows the great clinical value in approach selection,reduction of tissue and organ damage,reduction of surgery related complication and improving the success rate in robot-assisted laparoscopic surgery.