3D Cognitive Fusion Technique in Partial Nephrectomy for Completely Endophytic Tumors

Abstract

Introduction:

If the objective is to perform a nephron-conserving surgery, locating completely endophytic tumors represents a challenge and even more so if we talk about minimally invasive surgery. ¹ First, we have to achieve the oncologic objective to perform a complete resection, avoiding positive margins and generating the least damage to the unaffected parenchyma. ^2,3 The use of three-dimensional (3D) renal models allows localizing endophytic tumors with precision, it is a valid tool to achieve TRIFECTA in partial nephrectomy (negative margins, short ischemia time, preserve estimated glomerular filtration rate [GFR]). ^{4 –6} This navigation method could even replace the use of intraoperative ultrasound, which requires special training to use. ⁷

Objective:

To present four cases in whom we use cognitive fusion in 3D models to localize complex completely endophytic tumors. At our institution, we had a total of 505 minimally invasive partial nephrectomies from 2010 to 2023, of these 132 were endophytic tumors (defined as 50% or more), the average size of endophytic tumors was 26 mm, as expected, this group of tumors were tumors with a high RENAL score. The majority were clear cell variety and we achieved trifecta in 66.7% of endophytic tumors. We defined trifecta as having negative margins, warm ischemia time <25 minutes, and decreased GFR <15%. Of patients with endophytic tumors, 8.3% of patients with endophytic tumors had serious complications versus 3.5% of patients with exophytic tumors.

Conclusion:

Cognitive fusion or navigation with 3D models for the location of completely endophytic tumors could be effective, we could even dispense with the use of intraoperative ultrasound.

Patient Consent Statement:

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

The authors of this publication have not received external funding.

The authors of this publication have no conflicts of interest

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Runtime of video: 6 mins 38 secs