title: Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy.
abstract: Zero-ischemia robotic and laparoscopic partial nephrectomy, a novel concept, eliminates ischemia to the tumor-free normal kidney. Anatomic microdissection of tertiary/higher-order tumor-specific arteries is performed to selectively devascularize only the tumor, maintaining normal perfusion of the remaining kidney. A thorough understanding of renovascular tumor anatomy is essential. Based on 0.5-mm-slice thickness computed tomography scans, we developed a novel three-dimensional (3D) reconstruction technique that fuses three key anatomic aspects: surface-rendered tumor, semitransparent kidney, and extra- and intrarenal arterial anatomy. Four central completely intrarenal hilar masses underwent 3D reconstruction for surgical navigation during zero-ischemia partial nephrectomy. Negative surgical margins were obtained in all four cases, with no intraoperative complications or transfusions. For these challenging laparoscopically invisible masses, 3D image navigation precisely identified tumor-specific arterial branches, thus facilitating zero-ischemia partial nephrectomy without hilar cross clamping.
authors.affiliation: Center for Image-Guided Surgery and Center for Advanced Robotic and Laparoscopic Surgery, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA. ukimura@usc.edu
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakamoto
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007680:Kidney Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D042282:Microdissection; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D012371:Robotics; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome