Surgeries that can't wait: Nephrectomies during the COVID-19 pandemic
Dr. Francisco Cornejo
Hospital Metropolitano de Quito - Quito, Ecuador
✔ Increased understanding of the relationship between the blood vessels and the tumour.
✔ Redesign and optimisation of surgical plan
✔ Reduction of surgical time
✔ Reduced bleeding
✔ Improved interaction between the surgical team
✔ Improved safety at the time of surgery
✔ Guidance in the surgical approach during the intervention
✔ Improved postoperative patient care
A 38-year-old man with no history of illness was having a check-up in Buenos Aires, his hometown, when an abnormal mass was discovered in his right kidney. Although the patient had undergone the study in Argentina, he had been living in Quito for some time and due to the health situation of the Covid-19 virus, it was not possible for him to return there for surgery.
With the studies carried out both in Buenos Aires and in Quito, it was determined that it was an incidentaloma, an asymptomatic tumour, which was located in the lateral zone of the renal parenchyma.
3D anatomical model
◾ FDM technology
◾ Material: PLA
◾ Resolution: 0.02 mm
◾ Finish: One color
Surgical plan and results in operating room
The present case is the first that Dr Cornejo has performed with 3D models for surgical planning and guidance in the operating theatre. According to him, "the biomodels were very useful when dissecting the tumour".
The 3D reconstructions clearly showed that the tumour had proximal arteries supplying the area. This was of utmost importance as they noticed that there was a posterior artery that was not clearly visible in the patient's CT images. As a result, they redesigned their plan by refining the surgical strategy and proceeding with greater precision.
The plan chosen was an open surgical partial nephrectomy. A laparoscopic procedure was not performed as the location of the tumour was complex and therefore an open surgical procedure would decrease the risks, avoid extra bleeding and thus provide greater safety for the patient.
By planning the surgery step by step with the 3D physical models and the 3D virtual model, time was reduced. The surgical team proceeded quickly and effectively by only ligating the accessory artery that nourished the tumour (discovered with the model), leaving the rest intact. The tumour was then removed, which required 15 minutes for the removal of the tumour itself and 15 minutes for suturing the area. This procedure implied a 0 ischaemia time, i.e. no clamping of the main renal artery was performed. Consequently, this allowed for a minimum bleeding of 50 cc.
Finally, all of this clarity, says Dr. Cornejo, gave them a lot of peace of mind at the time of the operation. In addition, prior to the surgical procedure, he used the biomodels to explain to the patient his situation and the approach they were going to take for his surgery. In this way, he better understood the procedure they were going to perform and the risks involved, giving him greater peace of mind as well.
Testimony of the patient's family on the surgical team's actions:
Operated on in Ecuador
"When it became clear to our son that he had to have an operation to remove a kidney cyst, perhaps even taking out the affected organ, our world fell apart. We are one of those "seniors" who cannot move because of quarantine and our son has been living in Quito, Ecuador for a long time. The urgency of the matter did not matter. He couldn't come here for surgery and we couldn't travel to accompany him there. A combination of incredible people, such as Dr. Guillermo Mendoza, who made the first diagnosis in Buenos Aires, the solidary help of Swiss Medical -which our son keeps in Argentina- and the quality of the professionals of the Urology Service of the Hospital Metropolitano de Quito, headed by Dr. Francisco Javier Cornejo Proaño, made it possible that, while we write this letter, our son is already undergoing the postoperative period at home. Our thanks to everyone, with emphasis on the health professionals of Ecuador, a country that we have only recently got to know and that never ceases to surprise us with the enormous human quality of its people".