Single minimum incision endoscopic radical nephrectomy for renal tumors with preoperative virtual navigation using 3D-CT volume-rendering.
BACKGROUND
Single minimum incision endoscopic surgery (MIES) involves the use of a flexible high-definition laparoscope to facilitate open surgery. We reviewed our method of radical nephrectomy for renal tumors, which is single MIES combined with preoperative virtual surgery employing three-dimensional CT images reconstructed by the volume rendering method (3D-CT images) in order to safely and appropriately approach the renal hilar vessels. We also assessed the usefulness of 3D-CT images.


METHODS
Radical nephrectomy was done by single MIES via the translumbar approach in 80 consecutive patients. We performed the initial 20 MIES nephrectomies without preoperative 3D-CT images and the subsequent 60 MIES nephrectomies with preoperative 3D-CT images for evaluation of the renal hilar vessels and the relation of each tumor to the surrounding structures. On the basis of the 3D information, preoperative virtual surgery was performed with a computer.


RESULTS
Single MIES nephrectomy was successful in all patients. In the 60 patients who underwent 3D-CT, the number of renal arteries and veins corresponded exactly with the preoperative 3D-CT data (100% sensitivity and 100% specificity). These 60 nephrectomies were completed with a shorter operating time and smaller blood loss than the initial 20 nephrectomies.


CONCLUSIONS
Single MIES radical nephrectomy combined with 3D-CT and virtual surgery achieved a shorter operating time and less blood loss, possibly due to safer and easier handling of the renal hilar vessels.
Kamai
Takao
T
Department of Urology, Dokkyo Medical University, Mibu, Tochigi, Japan. kamait@dokkyomed.ac.jp
Furuya
Nobutaka
N
Kambara
Tsunehito
T
Abe
Hideyuki
H
Honda
Mikihiko
M
Shioyama
Yasukazu
Y
Kaji
Yasushi
Y
Yoshida
Ken-Ichiro
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface
J Urol. 2000 Oct;164(4):1153-9
10992356
Urology. 1994 Jan;43(1):125-9
8284875
J Urol. 1999 Apr;161(4):1097-102
10081846
J Comput Assist Tomogr. 2004 Jul-Aug;28(4):496-504
15232381
Nihon Hinyokika Gakkai Zasshi. 1994 Apr;85(4):599-603
8189657
Am J Surg Pathol. 1982 Oct;6(7):655-63
7180965
Int J Urol. 2002 Feb;9(2):73-6
12028294
AJR Am J Roentgenol. 1999 Nov;173(5):1273-7
10541104
World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
11234459
Nihon Hinyokika Gakkai Zasshi. 1989 Aug;80(8):1207-10
2585920
Radiographics. 2000 Mar-Apr;20(2):431-8
10715341
Int J Urol. 2004 Sep;11(9):714-20
15379934
Int J Urol. 2009 Oct;16(10):791-800
19694839
BJU Int. 2008 Jun;101(12):1493-6
18325059
J Urol. 2002 Nov;168(5):1933-6
12394679
BJU Int. 2009 Apr;103(8):1034-7
19245444
Int J Urol. 2004 Sep;11(9):693-9
15379930
Eur Urol. 1998;33(5):489-96
9643669