A novel 3-dimensional image analysis system for case-specific kidney anatomy and surgical simulation to facilitate clampless partial nephrectomy.
OBJECTIVE
To report our initial experience with the novel 3-dimensional (3D) image analysis system Synapse Vincent in clampless partial nephrectomy (PN), describing its advantages with regard to short-term surgical outcomes and its usefulness as an informed consent tool.


METHODS
Twenty-six patients with renal cell carcinoma underwent clampless PN navigated with the aid of case-specific 3D anatomic video images of the kidney, after surgical simulation using the same video system. Baseline characteristics were reviewed, and short-term surgical outcomes were recorded. Of the 26, 6 had imperative indications, and 22 were treated with a minimally invasive approach. Before tumor excision, the renal hilar vessels were meticulously dissected, and definite tumor feeders were selectively ligated. Before patients consented to PN, the surgical procedure and perioperative risks were explained to each patient using case-specific 3D video images; subsequently, surgeons asked patients whether the 3D images had helped them understand PN more clearly than 2D images would have.


RESULTS
All operations were successfully completed without clamping, with negative surgical margins. No patients required blood transfusions. During PN, the surgeons confirmed the accuracy of the reconstructed 3D images and surgical simulations in all cases. All patients answered that the 3D images had helped them understand their disease status and surgical risks.


CONCLUSIONS
This is the first report on the Synapse Vincent 3D image analysis system for kidney surgery. Its 3D images and surgical simulation helped not only surgeons in their performance of clampless PN but also patients in their understanding of the operation.
Department of Urology, National Cancer Center Hospital East, Chiba, Japan. Electronic address: yokomai@east.ncc.go.jp.
Yoshinobu
Y
Komai
Department of Urology, National Cancer Center Hospital East, Chiba, Japan.
Yasuyuki
Y
Sakai
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan.
Naoto
N
Gotohda
Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, Japan.
Tatsushi
T
Kobayashi
Department of Urology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Satoru
S
Kawakami
Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
Norio
N
Saito
D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D025321:Surgery, Computer-Assisted