Three-dimensional model-assisted minimally invasive partial nephrectomy: a systematic review with meta-analysis of comparative studies : review : kidney cancer
Context - 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. -...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
December 2022
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| In: |
European urology oncology
Year: 2022, Volume: 5, Issue: 6, Pages: 640-650 |
| ISSN: | 2588-9311 |
| DOI: | 10.1016/j.euo.2022.09.003 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.euo.2022.09.003 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S2588931122001663 
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| Author Notes: | 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, on behalf of the European Association of Urology Young Academic Urologists and the European Section of Uro-Technology |
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| 245 | 1 | 0 | |a Three-dimensional model-assisted minimally invasive partial nephrectomy |b a systematic review with meta-analysis of comparative studies : review : kidney cancer |c 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, on behalf of the European Association of Urology Young Academic Urologists and the European Section of Uro-Technology |
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| 520 | |a Context - 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. - Objectives - To summarize and evaluate the impact of 3D models on minimally invasive NSS in terms of perioperative, functional, and oncological outcomes. - Evidence acquisition - 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. - Evidence synthesis - 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). - Conclusions - 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. - Patient summary - 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. | ||
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| 650 | 4 | |a Laparoscopy | |
| 650 | 4 | |a Partial nephrectomy | |
| 650 | 4 | |a Renal cell carcinoma | |
| 650 | 4 | |a Robotics | |
| 650 | 4 | |a Three-dimensional models | |
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