Use of three-dimensional (3D) guidance for nephron-sparing surgery (NSS) has increased in popularity, especially for laparoscopic and robotic approaches. Different 3D visualization modalities have been developed as promising new tools for surgical planning and intraoperative navigation.
To summarize and evaluate the impact of 3D models on minimally invasive NSS in terms of perioperative, functional, and oncological outcomes.
A systematic literature search was conducted in December 2021 using the Medline (PubMed), Embase (Ovid), Scopus, and Web of Science databases. The protocol was registered on PROSPERO (CRD42022300948). The search strategy used the PICOS (Population, Intervention, Comparison, Outcome, Study design) criteria and article selection was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Meta-analysis was performed using the Mantel-Haenszel method for binary outcomes, with results summarized as the odds ratio (OR), and the inverse variance method for continuous data, with results reported as the mean difference (MD). All effect estimates are reported with the 95% confidence interval (CI) and p ≤ 0.05 was considered statistically significant. All analyses were performed using R software and the meta package.
The initial electronic search identified 450 papers, of which 17 met the inclusion criteria and were included in the analysis. Use of 3D technology led to a significant reduction in the global ischemia rate (OR 0.22, 95% CI 0.07-0.76; p = 0.02) and facilitated more frequent enucleation (OR 2.54, 95% CI 1.36-4.74; p < 0.01) and less frequent opening of the collecting system (OR 0.36, 95% CI 0.15-0.89; p = 0.03) and was associated with less blood loss (MD 23.1 ml, 95% CI 31.8-14.4; p < 0.01). 3D guidance for NSS was associated with a significant reduction in the transfusion rate (OR 0.20, 95% CI 0.07-0.56; p < 0.01). There were no significant differences in rates of conversion to radical nephrectomy, minor and major complications, change in glomerular filtration rate, or surgical margins (all p > 0.05).
3D guidance for NSS is associated with lower rates of detriment and surgical injury to the kidney. Specifically, a lower amount of nontumor renal parenchyma is exposed to ischemia or sacrificed during resection, and opening of the collecting system is less frequent. However, use of 3D technology does not lead to significant improvements in oncological or functional outcomes.
We reviewed the use of three-dimensional tools for minimally invasive surgery for partial removal of the kidney in patients with kidney cancer. The evidence suggests that these tools have benefits during surgery, but do not lead to significant improvements in cancer control or functional outcomes for patients.
European urology oncology. 2022 Oct 07 [Epub ahead of print]
Federico Piramide, Karl-Friedrich Kowalewski, Giovanni Cacciamani, Ines Rivero Belenchon, Mark Taratkin, Umberto Carbonara, Michele Marchioni, Ruben De Groote, Sophie Knipper, Angela Pecoraro, Filippo Turri, Paolo Dell'Oglio, Stefano Puliatti, Daniele Amparore, Gabriele Volpi, Riccardo Campi, Alessandro Larcher, Alex Mottrie, Alberto Breda, Andrea Minervini, Ahmed Ghazi, Prokar Dasgupta, Ali Gozen, Riccardo Autorino, Cristian Fiori, Michele Di Dio, Juan Gomez Rivas, Francesco Porpiglia, Enrico Checcucci, European Association of Urology Young Academic Urologists and the European Section of Uro-Technology
Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy; European Association of Urology Young Academic Urologists Robotic Surgery Working Group, Arnhem, The Netherlands. Electronic address: ., Department of Urology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands., Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; USC Institute of Urology, University of Southern California, Los Angeles, CA, USA., Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Urology and Nephrology Department, Virgen del Rocío University Hospital, Seville, Spain., Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, SS Annunziata Hospital, G. D'Annunzio University of Chieti, Chieti, Italy., European Association of Urology Young Academic Urologists Robotic Surgery Working Group, Arnhem, The Netherlands; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium., European Association of Urology Young Academic Urologists Robotic Surgery Working Group, Arnhem, The Netherlands; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Hospital Pederzoli, Peschiera del Garda, Italy., European Association of Urology Young Academic Urologists Robotic Surgery Working Group, Arnhem, The Netherlands; Department of Urology, Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy., European Association of Urology Young Academic Urologists Robotic Surgery Working Group, Arnhem, The Netherlands; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy; European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands., Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy., European Association of Urology Young Academic Urologists Robotic Surgery Working Group, Arnhem, The Netherlands; Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium., Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain., Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, University of Rochester Medical Center, Rochester, NY, USA., Medical Research Council Centre for Transplantation, Guy's Hospital Campus, King's Health Partners, King's College London, London, UK., Trakya Tip Fak Hospital, Edirne, Turkey., Division of Urology, VCU Health, Richmond, VA, USA., Department of Surgery, Division of Urology, SS Annunziata Hospital, Cosenza, Italy., Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Urology, Hospital Clinico San Carlos, Madrid, Spain., Association of Urology Young Academic Urologist-Urotechnology Working Party, Arnhem, The Netherlands; Department of Surgery, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy.