title: Feasibility and accuracy of computational robot-assisted partial nephrectomy planning by virtual partial nephrectomy analysis.
abstract: OBJECTIVE
  To evaluate the feasibility and accuracy of virtual partial nephrectomy analysis, including a color-coded three-dimensional virtual surgical planning and a quantitative functional analysis, in predicting the surgical outcomes of robot-assisted partial nephrectomy.
  
  
  METHODS
  Between 2012 and 2014, 20 patients underwent virtual partial nephrectomy analysis before undergoing robot-assisted partial nephrectomy. Virtual partial nephrectomy analysis was carried out with the following steps: (i) evaluation of the arterial branch for selective clamping by showing the vascular-supplied area; (ii) simulation of the optimal surgical margin in precise segmented three-dimensional model for prediction of collecting system opening; and (iii) detailed volumetric analyses and estimates of postoperative renal function based on volumetric change. At operation, the surgeon identified the targeted artery and determined the surgical margin according to the virtual partial nephrectomy analysis. The surgical outcomes between the virtual partial nephrectomy analysis and the actual robot-assisted partial nephrectomy were compared.
  
  
  RESULTS
  All 20 patients had negative cancer surgical margins and no urological complications. The tumor-specific renal arterial supply areas were shown in color-coded three-dimensional model visualization in all cases. The prediction value of collecting system opening was 85.7% for sensitivity and 100% for specificity. The predicted renal resection volume was significantly correlated with actual resected specimen volume (r(2) = 0.745, P < 0.001). The predicted estimated glomerular filtration rate was significantly correlated with actual postoperative estimated glomerular filtration rate (r(2) = 0.736, P < 0.001).
  
  
  CONCLUSIONS
  Virtual partial nephrectomy analysis is able to provide the identification of tumor-specific renal arterial supply, prediction of collecting system opening and prediction of postoperative renal function. This technique might allow urologists to compare various arterial clamping methods and resection margins with surgical outcomes in a non-invasive manner.
authors.affiliation: Department of Urology, Teikyo University, Tokyo, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isotani
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Shimoyama
authors.forename: Isao
authors.initials: I
authors.lastname: Yokota
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: China
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Hisasue
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Ide
authors.forename: Satoru
authors.initials: S
authors.lastname: Muto
authors.forename: Raizo
authors.initials: R
authors.lastname: Yamaguchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horie
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D021621:Imaging, Three-Dimensional; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: robot-assisted partial nephrectomy; simulation; three-dimensional anatomical model; virtual operation; volumetry