3D virtual model for robot-assisted partial nephrectomy in highly-complex cases (PADUA ⩾ 10).

IF 0.8 Q4 UROLOGY & NEPHROLOGY Urologia Journal Pub Date : 2024-08-01 Epub Date: 2024-05-21 DOI:10.1177/03915603241252905
Antonio Andrea Grosso, Fabrizio Di Maida, Luca Lambertini, Anna Cadenar, Simone Coco, Elena Ciaralli, Vincenzo Salamone, Gianni Vittori, Agostino Tuccio, Andrea Mari, Andrea Minervini
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Abstract

Purpose: To compare two cohorts of patients submitted to robot-assisted partial nephrectomy (RAPN) for highly-complex renal masses (PADUA ⩾ 10) with versus without the use of 3DVMs.

Materials and methods: We screened a prospective consecutive cohort of 152 patients submitted to RAPN with 3DVM and 1264 patients submitted to RAPN without 3DVM between 2019 and 2022. Only PADUA ⩾ 10 cases were considered eligible for analysis. Propensity score matching (PSM) analysis was applied. Primary endpoint was to evaluate whereas RAPNs with 3DVM were superior in terms of functional outcomes at 12-month. Secondary outcomes were to compare perioperative and oncological outcomes. Multivariable logistic regression analyses (MVA) tested the associations of clinically significant eGFR drop and 3DVMs. Subgroups analysis was performed for PAUDA-risk categories.

Results: Thirty seven patients for each group were analyzed after PSM. RAPN with 3DVM presented a higher rate of selective/no clamping procedure (32.5% vs 16.2%, p = 0.03) and a higher enucleation rate (43.2% vs 29.8%, p = 0.04). Twelve-month functional preservation performed better within 3DVM group in terms of creatinine serum level (median 1.2 [IQR 1.1-1.4] vs 1.6 [IQR 1.1-1.8], p = 0.03) and eGFR (median 64.6 [IQR 56.2-74.1] vs 52.3 [IQR 49.2-74.1], p = 0.03). MVA confirmed 3DVM as a protective factor for clinically significant eGFR drop in this subgroup of patients.

Conclusions: RAPN performed with the use of 3DVM assistance for PADUA ⩾ 10 cases resulted in lower incidence of global ischemia and higher rate of enucleations. The positive impact of such technology was found at 12-month follow-up.

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用于高度复杂病例(PADUA ⩾ 10)机器人辅助肾部分切除术的三维虚拟模型。
目的:比较两组因高度复杂肾肿块(PADUA ⩾ 10)而接受机器人辅助肾部分切除术(RAPN)的患者使用 3DVM 与不使用 3DVM 的情况:我们筛选了2019年至2022年期间接受RAPN治疗的152名患者和接受RAPN治疗的1264名患者,这两组患者均使用了3DVM。只有 PADUA ⩾ 10 的病例才符合分析条件。采用倾向评分匹配(PSM)分析。主要终点是评估使用 3DVM 的 RAPNs 在 12 个月的功能结果方面是否更优。次要结果是比较围手术期和肿瘤学结果。多变量逻辑回归分析(MVA)检验了临床上明显的 eGFR 下降与 3DVM 的相关性。对PAUDA风险类别进行了分组分析:经过 PSM 分析,每组有 37 名患者。RAPN与3DVM的选择性/不钳夹率较高(32.5% vs 16.2%,P = 0.03),去核率较高(43.2% vs 29.8%,P = 0.04)。就血清肌酐水平(中位数 1.2 [IQR 1.1-1.4] vs 1.6 [IQR 1.1-1.8],p = 0.03)和 eGFR(中位数 64.6 [IQR 56.2-74.1] vs 52.3 [IQR 49.2-74.1],p = 0.03)而言,3DVM 组的 12 个月功能保存情况更好。MVA证实3DVM是该亚组患者eGFR临床显著下降的保护因素:结论:使用 3DVM 辅助对 PADUA ⩾ 10 例患者进行 RAPN,可降低全身缺血发生率,提高去核率。在 12 个月的随访中发现了该技术的积极影响。
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来源期刊
Urologia Journal
Urologia Journal UROLOGY & NEPHROLOGY-
CiteScore
0.60
自引率
12.50%
发文量
66
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