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New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy

Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generat...

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Autores principales: Amparore, Daniele, Piramide, Federico, Verri, Paolo, Checcucci, Enrico, De Cillis, Sabrina, Piana, Alberto, Volpi, Gabriele, Burgio, Mariano, Busacca, Giovanni, Colombo, Marco, Fiori, Cristian, Porpiglia, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136700/
https://www.ncbi.nlm.nih.gov/pubmed/37185417
http://dx.doi.org/10.3390/curroncol30040304
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author Amparore, Daniele
Piramide, Federico
Verri, Paolo
Checcucci, Enrico
De Cillis, Sabrina
Piana, Alberto
Volpi, Gabriele
Burgio, Mariano
Busacca, Giovanni
Colombo, Marco
Fiori, Cristian
Porpiglia, Francesco
author_facet Amparore, Daniele
Piramide, Federico
Verri, Paolo
Checcucci, Enrico
De Cillis, Sabrina
Piana, Alberto
Volpi, Gabriele
Burgio, Mariano
Busacca, Giovanni
Colombo, Marco
Fiori, Cristian
Porpiglia, Francesco
author_sort Amparore, Daniele
collection PubMed
description Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generation of 3DVMs, which consider the perfusion volumes of the kidney. Patients listed for RAPN from 2021 to 2022 were recruited. A selective clamping strategy was designed and intraoperatively performed based on the specifically generated 3DVMs. The effectiveness of selective clamping was evaluated using near-infrared-fluorescence imaging (NIRF) and 3DVM. Perfusion areas extensions were compared, and relevant preoperative characteristics were analyzed. In 61 of 80 (76.25%) cases, selective clamping was performed. The concordance between the 3DVM areas and the NIRF-enhanced areas was verified (k = 0.91). According to the distribution of perfused areas crossing the tumor, there were one, two, three, four, and five crossing areas, with relative perfusion rates of 13.75%, 35%, 32.5%, 13.75%, and 5%, respectively. Lesion diameter and mesorenal location were the only factors related to a higher number (>3) of perfusion volumes crossing the lesion. The implementation of mathematical algorithms to 3DVMs allows for precise estimation of the perfusion zone of each arterial branch feeding the organ, leading to the performance of safe and effective pedicle management planning.
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spelling pubmed-101367002023-04-28 New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy Amparore, Daniele Piramide, Federico Verri, Paolo Checcucci, Enrico De Cillis, Sabrina Piana, Alberto Volpi, Gabriele Burgio, Mariano Busacca, Giovanni Colombo, Marco Fiori, Cristian Porpiglia, Francesco Curr Oncol Article Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generation of 3DVMs, which consider the perfusion volumes of the kidney. Patients listed for RAPN from 2021 to 2022 were recruited. A selective clamping strategy was designed and intraoperatively performed based on the specifically generated 3DVMs. The effectiveness of selective clamping was evaluated using near-infrared-fluorescence imaging (NIRF) and 3DVM. Perfusion areas extensions were compared, and relevant preoperative characteristics were analyzed. In 61 of 80 (76.25%) cases, selective clamping was performed. The concordance between the 3DVM areas and the NIRF-enhanced areas was verified (k = 0.91). According to the distribution of perfused areas crossing the tumor, there were one, two, three, four, and five crossing areas, with relative perfusion rates of 13.75%, 35%, 32.5%, 13.75%, and 5%, respectively. Lesion diameter and mesorenal location were the only factors related to a higher number (>3) of perfusion volumes crossing the lesion. The implementation of mathematical algorithms to 3DVMs allows for precise estimation of the perfusion zone of each arterial branch feeding the organ, leading to the performance of safe and effective pedicle management planning. MDPI 2023-04-01 /pmc/articles/PMC10136700/ /pubmed/37185417 http://dx.doi.org/10.3390/curroncol30040304 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Amparore, Daniele
Piramide, Federico
Verri, Paolo
Checcucci, Enrico
De Cillis, Sabrina
Piana, Alberto
Volpi, Gabriele
Burgio, Mariano
Busacca, Giovanni
Colombo, Marco
Fiori, Cristian
Porpiglia, Francesco
New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
title New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
title_full New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
title_fullStr New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
title_full_unstemmed New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
title_short New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
title_sort new generation of 3d virtual models with perfusional zones: perioperative assistance for the best pedicle management during robotic partial nephrectomy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136700/
https://www.ncbi.nlm.nih.gov/pubmed/37185417
http://dx.doi.org/10.3390/curroncol30040304
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