3D Urology: Resection of renal tumours in critically ill patients
Dr. Claudio Koren
Hospital Churruca Visca - Ciudad de Buenos Aires, Argentina
✔ Understand in detail the relationship of the tumour to the urinary tract.
✔ Define the surgical approach
✔ Identify the structures of interest during surgery
✔ Provide greater safety for surgeons and the patient
A 66-year-old male patient, with a history of smoking, appendectomy, aorto-aortic interposition with an endoaneurysmal replacement with a straight prosthesis, attends the emergency room for haematuria and clotting.
A CT scan was performed and a very large tumour was discovered in the right kidney. Consequently, a right radical nephrectomy was performed and the pathological anatomy defined the tumour mass as a clear cell renal carcinoma pT3a measuring 11x9x6cm.
In a control CT scan, a 3cm nodular lesion appears in the posterior leaflet of the left kidney. Less than 50% of the lesion is exophytic, 4mm from the excretory system and crosses the inferior polar line, therefore the renal score is 8 points. In addition, a double renal artery and a simple cyst in the anterior leaflet were also found.
3D anatomical model
Given the complexity of the case, Dr. Koren decided to use 3D models in order to plan the patient's intervention and provide safe and accurate surgery. To do so, he had three tailor-made biomodels:
3D model of the complete kidney
3D model of the urinary tract with tumour
3D model of the arterial network with tumour
Characteristics of the biomodels:
◾ FDM technology - Material: PLA
◾Resolution: 0.2 mm - Finishing: Multiple colours
Surgical planning and outcomes in the operating room
For greater safety, given the patient's state of health and history, the surgical team decided to perform the lumpectomy by open surgery, mainly because they did not perform vascular clamping.
They performed an oblique laparotomy, where they freed the kidney, recognised the structures and then proceeded to remove the tumour while performing manual compression, avoiding clamping so as not to alter renal function.
The 3D biomodel, which was taken to surgery, was constantly consulted and thanks to it they were able to correctly identify the anatomical structures of interest with ease. This was not such a simple task since the renal pedicle was compromised by the significant fibrosis generated by the aneurysm treatment surgery. This was especially useful in identifying the ureter, which was practically behind the aneurysmal aorta, hindering its visualisation.
In addition, the 3D anatomical model showed in detail the intimate relationship between the tumour and the urinary tract, information that helped in performing an adequate and more conservative resection.
More on uro-oncology: "Personalised 3D planning for cancer patient with horseshoe kidney". Dr Alberto Jurado at the Hospital Italiano de Buenos Aires used 3D models to plan the resection of a tumour in a patient with horseshoe kidneys.