The Three-Dimensional Virtual Surgical Simulation and Surgical Assistance for Optimizing Robotic Partial Nephrectomy

摘要

Robot-assisted partial nephrectomy (RAPN) has been accepted as the standard treatment recommended for relatively small renal mass or even the T2 renal carcinoma in experienced hospitals as Nephron Sparing Surgery. To obtain better RAPN surgical outcomes, the understanding of surgical anatomies such as the position of intra-renal structure and the positional relationship of each structure should be detailed in a three-dimensional (3D) manner. The 3D virtual surgical simulation for partial nephrectomy based on the image segmentation method with high-resolution CT can provide the 3D anatomical details of the renal tumor focusing on their relationships with the arterial and venous branches as well as with the intrarenal portion of the urinary collecting system. This imaging application is also used as image guidance during the surgery, and it indicated that it provides the improvement of clinical outcomes such as the duration of hospitalization, transfusion, and major postoperative complications as well as conversion to radical nephrectomy or open partial nephrectomy. In this chapter, we describe the basics of the 3D imaging assistance methods for partial nephrectomy and the benefit of 3D virtual surgical simulation in optimizing the outcome of the RAPN.