Virtual planning of laparoscopic partial nephrectomy in the treatment of localized renal cancer

Purpose of the study. To assess the effectiveness and advantages of using 3d computer technologies for performing organ-saving operations in patients with localized cancer of the kidney parenchyma from laparoscopic access. Materials and methods. In retrospect, the results of surgical treatment of 558 patients with renal cell carcinoma (RCC) in the Urology Clinic of the First Moscow State Medical University named after IM Sechenov were analyzed in a retrospective for the period from January 2012 to May 2017. The mean age of the patients was 55.85 ± 10.5 (25-78) years. There were 307 men (55%), women - 251 (45%). The organ-carrying operations were performed in 244 patients (43.7%) with laparoscopic access. In 314 (56.3%) observations, laparoscopic resection of the kidney (lRP) was performed. In addition to the standard methods of preoperative examination, 248 (44.4%) patients underwent 3d modeling and multivariate virtual implementation of operations using the 3d modeling program "Amira" based on the performed multi-helical computed tomography (MSCT). Intraoperational data of virtual constructions were used by surgeons for the purpose of navigation. Benefits were performed by 7 urologists of the clinic with different experience of performing laparoscopic operations. To conduct a correct statistical analysis of the treatment results from each group of patients with and without 3d planning, comparable pairs were selected according to the main characteristics: accounting for the homogeneity of the operators and their experience in performing the operation, tumor size and location (ratio to the segment, front and back surfaces ), a variant of surgical access. After the selection of homogeneous pairs, we obtained two homogeneous groups of patients with lRP performed n = 106 patients with lRP performed in 53 patients in each group with and without 3d planning. Results. With 3d virtual planning of surgical care in patients with RCC in the volume of lRS in homogeneous comparison groups (n = 106), there is a statistically significant advantage over patients without virtual planning: according to the time of thermal ischemia 12.0 ± 6.4 min (p = 0.010), the time of the operation was 113.4 ± 39.4 min (p = 0.0001), the blood loss value was 102.8 ± 98.2 ml (p = 0.001). Twenty-four hours after lRP in both groups, the reduction in GFR was <10% of the baseline level, there was no statistical difference between the two groups of patients (p = 0.088). After 6 months, the level of GFR in the group with 3d planning was reduced by 9.09% and in the group without 3d operations planning by 13.89% (p = 0.047). Twelve months after lRP in homogeneous analysis groups, it was found that the GFR level did not reach the level before surgery in both groups, in the group with 3d surgery planning, GFR decreased from baseline to 7.14%, in the group of patients without 3d, 9.89% (p = 0.023). The conclusion. The use of computer-assisted technologies in the scope of 3d planning and virtual implementation of operations makes it possible to improve the immediate and functional results of real operational benefits in patients with RCC in performing organ-preserving operations from laparoscopic access.

трехмерные технологии, виртуальное планирование, рак почки, лапароскопия, резекция почки, three-dimensional technologies, virtual planning, kidney cancer, laparoscopy, kidney resection

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