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    Impact of Three-dimensional Printing in Urology: State of the Art and Future Perspectives. A Systematic Review by ESUT-YAUWP Group. Cacciamani Giovanni E,Okhunov Zhamshid,Meneses Aurus Dourado,Rodriguez-Socarras Moises Elias,Rivas Juan Gomez,Porpiglia Francesco,Liatsikos Evangelos,Veneziano Domenico European urology CONTEXT:Three-dimensional (3D) printing has profoundly impacted biomedicine. It has been used to pattern cells; replicate tissues or full organs; create surgical replicas for planning, counseling, and training; and build medical device prototypes and prosthetics, and in numerous other applications. OBJECTIVE:To assess the impact of 3D printing for surgical planning, training and education, patient counseling, and costs in urology. EVIDENCE ACQUISITION:A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. EVIDENCE SYNTHESIS:After screening, 4026 publications were identified for detailed review, of which 52 were included in the present systematic review: two papers reported the use of 3D-printing modeling for adrenal cancer, two papers for urethrovesical anastomosis, 24 papers for kidney transplantation and renal cancer, 13 papers for prostate cancer, seven papers for pelvicalyceal system procedures, and three papers for ureteral stents, and three papers reported 3D-printed biological scaffold development. CONCLUSIONS:Three-dimensional printing shows revolutionary potentials for patient counseling, pre- and intraoperative surgical planning, and education in urology. Together with the "patient-tailored" presurgical planning, it puts the basis for 3D-bioprinting technology. Although costs and "production times" remain the major concerns, this kind of technology may represent a step forward to meet patients' and surgeons' expectations. PATIENT SUMMARY:Three-dimensional printing has been used for several purposes to help the surgeon better understand anatomy, sharpen his/her skills, and guide the identification of lesions and their relationship with surrounding structures. It can be used for surgical planning, education, and patient counseling to improve the decision-making process. 10.1016/j.eururo.2019.04.044
    Utility of patient-specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot-assisted laparoscopic partial nephrectomy. von Rundstedt Friedrich-Carl,Scovell Jason M,Agrawal Smriti,Zaneveld Jacques,Link Richard E BJU international OBJECTIVE:To describe our experience using patient-specific tissue-like kidney models created with advanced three-dimensional (3D)-printing technology for preoperative planning and surgical rehearsal prior to robot-assisted laparoscopic partial nephrectomy (RALPN). PATIENTS AND METHODS:A feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D-print kidney models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction, we generated pre-surgical models using a silicone-based material. All surgical rehearsals were performed using the da Vinci robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA) before the actual procedure. To determine construct validity, we compared resection times between the model and actual tumour in a patient-specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumour volume resected for each model and patient tumour. RESULTS:We generated patient-specific models for 10 patients with complex tumour anatomy. R.E.N.A.L. nephrometry scores were between 7 and 11, with a mean maximal tumour diameter of 40.6 mm. The mean resection times between model and patient (6:58 vs 8:22 min, P = 0.162) and tumour volumes between the computer model, excised model, and excised tumour (38.88 vs 38.50 vs 41.79 mm , P = 0.98) were not significantly different. CONCLUSIONS:We have developed a patient-specific pre-surgical simulation protocol for RALPN. We demonstrated construct validity and provided accurate representation of enucleation time and resected tissue volume. This simulation platform can assist in surgical decision-making, provide preoperative rehearsals, and improve surgical training. 10.1111/bju.13712
    Development of a Patient-specific Tumor Mold Using Magnetic Resonance Imaging and 3-Dimensional Printing Technology for Targeted Tissue Procurement and Radiomics Analysis of Renal Masses. Dwivedi Durgesh Kumar,Chatzinoff Yonatan,Zhang Yue,Yuan Qing,Fulkerson Michael,Chopra Rajiv,Brugarolas James,Cadeddu Jeffrey A,Kapur Payal,Pedrosa Ivan Urology OBJECTIVE:To implement a platform for colocalization of in vivo quantitative multiparametric magnetic resonance imaging features with ex vivo surgical specimens of patients with renal masses using patient-specific 3-dimensional (3D)-printed tumor molds, which may aid in targeted tissue procurement and radiomics and radiogenomic analyses. MATERIALS AND METHODS:Volumetric segmentation of 6 renal masses was performed with 3D Slicer (http://www.slicer.org) to create a 3D tumor model. A slicing guide template was created with specialized software, which included notches corresponding to the anatomic locations of the magnetic resonance images. The tumor model was subtracted from the slicing guide to create a depression in the slicing guide corresponding to the exact size and shape of the tumor. A customized, tumor-specific, slicing guide was then printed using a 3D printer. After partial nephrectomy, the surgical specimen was bivalved through the preselected magnetic resonance imaging (MRI) plane. A thick slab of the tumor was obtained, fixed, and processed as a whole-mount slide and was correlated to multiparametric MRI findings. RESULTS:All patients successfully underwent partial nephrectomy and adequate fitting of the tumor specimens within the 3D mold was achieved in all tumors. Distinct in vivo MRI features corresponded to unique pathologic characteristics in the same tumor. The average cost of printing each mold was US$160.7 ± 111.1 (range: US$20.9-$350.7). CONCLUSION:MRI-based preoperative 3D printing of tumor-specific molds allow for accurate sectioning of the tumor after surgical resection and colocalization of in vivo imaging features with tissue-based analysis in radiomics and radiogenomic studies. 10.1016/j.urology.2017.08.056
    Development and validation of 3D printed virtual models for robot-assisted radical prostatectomy and partial nephrectomy: urologists' and patients' perception. Porpiglia Francesco,Bertolo Riccardo,Checcucci Enrico,Amparore Daniele,Autorino Riccardo,Dasgupta Prokar,Wiklund Peter,Tewari Ashutosh,Liatsikos Evangelos,Fiori Cristian, World journal of urology PURPOSE:To test the face and content validity of 3D virtual-rendered printed models used before robot-assisted prostate cancer and nephron-sparing surgery. METHODS:Patients who underwent live surgery during an international urological meeting organized in January 2017 were enrolled. Those with organ-confined prostate cancer underwent robot-assisted radical prostatectomy. Patients with a single renal tumor underwent minimally invasive nephron-sparing surgery. High-resolution (HR) imaging was obtained for all patients. Those with kidney tumors received contrast-enhanced CT scan with angiography; those with prostate cancer underwent mp-MRI. Images in DICOM format were processed by dedicated software. The first step was the rendering of a 3D virtual model. The models were then printed. They were presented during the live surgery of the urological meeting. All the participants and the operated patients were asked to fill a questionnaire about their opinion expressed in Likert scale (1-10) about the use and application of the 3D printed models. RESULTS:18 patients were enrolled, including 8 undergoing robot-assisted radical prostatectomy and 10 undergoing minimally invasive partial nephrectomy. For each patient, a virtual 3D printed model was created. The attendants rated the utility of printed models in surgical planning, anatomical representation and the role of technology in surgical training as 8/10, 10/10 and 9/10, respectively. All patients reported favorable feedbacks (from 9 to 10/10) about the use of the technology during the case discussion with the surgeon. CONCLUSIONS:In our experience, 3D printing technology has been perceived as a useful tool for the purpose of surgical planning, physician education/training and patient counseling. Further researches are expected to increase the level of evidence. 10.1007/s00345-017-2126-1
    Patient-specific 3D printed and augmented reality kidney and prostate cancer models: impact on patient education. Wake Nicole,Rosenkrantz Andrew B,Huang Richard,Park Katalina U,Wysock James S,Taneja Samir S,Huang William C,Sodickson Daniel K,Chandarana Hersh 3D printing in medicine BACKGROUND:Patient-specific 3D models are being used increasingly in medicine for many applications including surgical planning, procedure rehearsal, trainee education, and patient education. To date, experiences on the use of 3D models to facilitate patient understanding of their disease and surgical plan are limited. The purpose of this study was to investigate in the context of renal and prostate cancer the impact of using 3D printed and augmented reality models for patient education. METHODS:Patients with MRI-visible prostate cancer undergoing either robotic assisted radical prostatectomy or focal ablative therapy or patients with renal masses undergoing partial nephrectomy were prospectively enrolled in this IRB approved study (n = 200). Patients underwent routine clinical imaging protocols and were randomized to receive pre-operative planning with imaging alone or imaging plus a patient-specific 3D model which was either 3D printed, visualized in AR, or viewed in 3D on a 2D computer monitor. 3D uro-oncologic models were created from the medical imaging data. A 5-point Likert scale survey was administered to patients prior to the surgical procedure to determine understanding of the cancer and treatment plan. If randomized to receive a pre-operative 3D model, the survey was completed twice, before and after viewing the 3D model. In addition, the cohort that received 3D models completed additional questions to compare usefulness of the different forms of visualization of the 3D models. Survey responses for each of the 3D model groups were compared using the Mann-Whitney and Wilcoxan rank-sum tests. RESULTS:All 200 patients completed the survey after reviewing their cases with their surgeons using imaging only. 127 patients completed the 5-point Likert scale survey regarding understanding of disease and surgical procedure twice, once with imaging and again after reviewing imaging plus a 3D model. Patients had a greater understanding using 3D printed models versus imaging for all measures including comprehension of disease, cancer size, cancer location, treatment plan, and the comfort level regarding the treatment plan (range 4.60-4.78/5 vs. 4.06-4.49/5, p < 0.05). CONCLUSIONS:All types of patient-specific 3D models were reported to be valuable for patient education. Out of the three advanced imaging methods, the 3D printed models helped patients to have the greatest understanding of their anatomy, disease, tumor characteristics, and surgical procedure. 10.1186/s41205-019-0041-3
    [Printing of 3D models to aid in complex renal surgery.] Ciappara Paniagua Marco,Galante Romo María Isabel,Moreno Sierra Jesús Archivos espanoles de urologia OBJECTIVE:Nephron sparing surgery is the gold standard in cT1 renal tumor. In order to perform a safe and effective surgery is essential a good radiological study. 3D printing is a new tool that allows the creation of virtual and physical trustworthy 3D reproduction of organs or anatomical structures of patients. METHOD:Non systematic review of PubMed database about the usefulness of 3D printing in renal surgery. RESULTS:3D printing has a potential use in surgery planning, resident education and improving the communication and understanding of our patients. CONCLUSION:Today the number of publications and the use of these technique are still low. 3D printing is a useful tool in order to improve communication with patients and has a potential role in resident education. 3D printing technology could be useful in surgically complex cases since provides an exact model of the organ and the lesion before the intervention allowing a better surgery planning to the surgeon.
    3D-printed soft-tissue physical models of renal malignancies for individualized surgical simulation: a feasibility study. Maddox Michael M,Feibus Allison,Liu James,Wang Julie,Thomas Raju,Silberstein Jonathan L Journal of robotic surgery To construct patient-specific physical three-dimensional (3D) models of renal units with materials that approximates the properties of renal tissue to allow pre-operative and robotic training surgical simulation, 3D physical kidney models were created (3DSystems, Rock Hill, SC) using computerized tomography to segment structures of interest (parenchyma, vasculature, collection system, and tumor). Images were converted to a 3D surface mesh file for fabrication using a multi-jet 3D printer. A novel construction technique was employed to approximate normal renal tissue texture, printers selectively deposited photopolymer material forming the outer shell of the kidney, and subsequently, an agarose gel solution was injected into the inner cavity recreating the spongier renal parenchyma. We constructed seven models of renal units with suspected malignancies. Partial nephrectomy and renorrhaphy were performed on each of the replicas. Subsequently all patients successfully underwent robotic partial nephrectomy. Average tumor diameter was 4.4 cm, warm ischemia time was 25 min, RENAL nephrometry score was 7.4, and surgical margins were negative. A comparison was made between the seven cases and the Tulane Urology prospectively maintained robotic partial nephrectomy database. Patients with surgical models had larger tumors, higher nephrometry score, longer warm ischemic time, fewer positive surgical margins, shorter hospitalization, and fewer post-operative complications; however, the only significant finding was lower estimated blood loss (186 cc vs 236; p = 0.01). In this feasibility study, pre-operative resectable physical 3D models can be constructed and used as patient-specific surgical simulation tools; further study will need to demonstrate if this results in improvement of surgical outcomes and robotic simulation education. 10.1007/s11701-017-0680-6
    Touching the future: three-dimensional printing facilitates preoperative planning, realistic simulation and enhanced precision in robot-assisted laparoscopic partial nephrectomy. de Luyk Nicolò,Namdarian Benjamin,Challacombe Benjamin BJU international 10.1111/bju.13800
    Partial nephrectomy: three dimensional (3D) models from preoperative computed tomography is the future to identify the exact loction of the tumor. Favorito Luciano A International braz j urol : official journal of the Brazilian Society of Urology 10.1590/S1677-5538.IBJU.2018.05.01
    Personalized 3D kidney model produced by rapid prototyping method and its usefulness in clinical applications. Lee Hakmin,Nguyen Ngoc Ha,Hwang Sung Il,Lee Hak Jong,Hong Sung Kyu,Byun Seok-Soo International braz j urol : official journal of the Brazilian Society of Urology BACKGROUND:Three-dimensional (3D) printing has been introduced as a novel technique to produce 3D objects. We tried to evaluate the clinical usefulness of 3D-printed renal model in performing partial nephrectomy (PN) and also in the education of medical students. MATERIALS AND METHODS:We prospectively produced personalized renal models using 3D-printing methods from preoperative computed tomography (CT) images in a total of 10 patients. Two different groups (urologist and student group) appraised the clinical usefulness of 3D-renal models by answering questionnaires. RESULTS:After application of 3D renal models, the urologist group gave highly positive responses in asking clinical usefulness of 3D-model among PN (understanding personal anatomy: 8.9 / 10, preoperative surgical planning: 8.2 / 10, intraoperative tumor localization: 8.4 / 10, plan for further utilization in future: 8.3 / 10, clinical usefulness in complete endophytic mass: 9.5 / 10). The student group located each renal tumor correctly in 47.3% when they solely interpreted the CT images. After the introduction of 3D-models, the rate of correct answers was significantly elevated to 70.0% (p < 0.001). The subjective difficulty level in localizing renal tumor was also significantly low (52% versus 27%, p < 0.001) when they utilized 3D-models. CONCLUSION:The personalized 3D renal model was revealed to significantly enhance the understanding of correct renal anatomy in patients with renal tumors in both urologist and student groups. These models can be useful for establishing the perioperative planning and also education program for medical students. 10.1590/S1677-5538.IBJU.2018.0162
    Three-dimensional printing for laparoscopic partial nephrectomy in patients with renal tumors. Fan Gang,Meng Yanbin,Zhu Shuai,Ye Mingji,Li Mingfeng,Li Feiping,Ye Yuanchun,Liu Zhizhong,Weiqin Han,Xie Yu The Journal of international medical research 10.1177/0300060519862058
    Individualized Physical 3-dimensional Kidney Tumor Models Constructed From 3-dimensional Printers Result in Improved Trainee Anatomic Understanding. Knoedler Margaret,Feibus Allison H,Lange Andrew,Maddox Michael M,Ledet Elisa,Thomas Raju,Silberstein Jonathan L Urology OBJECTIVE:To evaluate the effect of 3-dimensionally (3D) printed physical renal models with enhancing masses on medical trainee characterization, localization, and understanding of renal malignancy. METHODS:Proprietary software was used to import standard computed tomography (CT) cross-sectional imaging into 3D printers to create physical models of renal units with enhancing renal lesions in situ. Six different models were printed from a transparent plastic resin; the normal parenchyma was printed in a clear, translucent plastic, with a red hue delineating the suspicious renal lesion. Medical students, who had completed their first year of training, were given an overview and tasked with completion of RENAL nephrometry scores, separately using CT imaging and 3D models. Trainees were also asked to complete a questionnaire about their experience. Variability between trainees was assessed by intraclass correlation coefficients (ICCs), and kappa statistics were used to compare the trainee to experts. RESULTS:Overall trainee nephrometry score accuracy was significantly improved with the 3D model vs CT scan (P <.01). Furthermore, 3 of the 4 components of the nephrometry score (radius, nearness to collecting system, and location) showed significant improvement (P <.001) using the models. There was also more consistent agreement among trainees when using the 3D models compared with CT scans to assess the nephrometry score (intraclass correlation coefficient, 0.28 for CT scan vs 0.72 for 3D models). Qualitative evaluation with questionnaires filled out by the trainees further confirmed that the 3D models improved their ability to understand and conceptualize the renal mass. CONCLUSION:Physical 3D models using readily available printing techniques improve trainees' understanding and characterization of individual patients' enhancing renal lesions. 10.1016/j.urology.2015.02.053
    Laparoscopic Partial Nephrectomy with Precise Segmental Renal Artery Clamping for Clinical T1b Tumors. Qian Jian,Li Pu,Qin Chao,Zhang Shaobo,Bao Meiling,Liang Chao,Cao Qiang,Li Jie,Shao Pengfei,Yin Changjun Journal of endourology OBJECTIVE:To assess the technique and short-term outcomes of laparoscopic partial nephrectomy (LPN) with precise segmental renal artery clamping for clinical T1b (cT1b) tumors and to analyze the possible factors affecting the glomerular filtration rate (GFR) reduction. MATERIALS AND METHODS:This retrospective study investigated the outcomes of 72 patients with cT1b tumors who received LPN from June 2008 to May 2014. Based on three-dimensional dynamic renal vascular models built before surgery, target arteries were precisely clamped and tumors were removed under regional parenchymal ischemia. Perioperative and follow-up outcomes were analyzed. RESULTS:All the LPN procedures were effectively performed using the novel technique, without converting to main renal artery clamping or open surgery. The mean operative time was 86 min, with a mean warm ischemic time of 25 min. The median estimated blood loss was 200 mL (range: 80-800). The postoperative mean GFR was 64% of the preoperative baseline, and the total complication rate was 19.4%. In multivariable analyses, the two independent factors affecting postoperative GFR were the RENAL nephrometry score (RNS) and number of intraoperative clamped segmental arteries. The median follow-up was 24 months (range: 6-72). The overall, recurrence-free, and cancer-specific survival rates were 100%, 95.8%, and 100%, respectively. CONCLUSIONS:For patients with cT1b tumor, LPN with precise segmental renal artery clamping is safe and feasible for removing tumors and preserving the blood supply and normal renal parenchyma. Short-term oncologic and functional outcomes were satisfactory. Postoperative GFR was related to the preoperative RNS and number of intraoperative clamped segmental arteries. 10.1089/end.2015.0359
    Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy. Ukimura Osamu,Nakamoto Masahiko,Gill Inderbir S European urology Zero-ischemia robotic and laparoscopic partial nephrectomy, a novel concept, eliminates ischemia to the tumor-free normal kidney. Anatomic microdissection of tertiary/higher-order tumor-specific arteries is performed to selectively devascularize only the tumor, maintaining normal perfusion of the remaining kidney. A thorough understanding of renovascular tumor anatomy is essential. Based on 0.5-mm-slice thickness computed tomography scans, we developed a novel three-dimensional (3D) reconstruction technique that fuses three key anatomic aspects: surface-rendered tumor, semitransparent kidney, and extra- and intrarenal arterial anatomy. Four central completely intrarenal hilar masses underwent 3D reconstruction for surgical navigation during zero-ischemia partial nephrectomy. Negative surgical margins were obtained in all four cases, with no intraoperative complications or transfusions. For these challenging laparoscopically invisible masses, 3D image navigation precisely identified tumor-specific arterial branches, thus facilitating zero-ischemia partial nephrectomy without hilar cross clamping. 10.1016/j.eururo.2011.07.068
    Three-Dimensional Printing as an Interdisciplinary Communication Tool: Preparing for Removal of a Giant Renal Tumor and Atrium Neoplastic Mass. Golab Adam,Slojewski Marcin,Brykczynski Miroslaw,Lukowiak Magdalena,Boehlke Marek,Matias Daniel,Smektala Tomasz The heart surgery forum Three-dimensional (3D) printing involves preparing 3D objects from a digital model. These models can be used to plan and practice surgery. We used 3D printing to plan for a rare complicated surgery involving the removal of a renal tumor and neoplastic mass, which reached the heart atrium. A printed kidney model was an essential element of communication for physicians with different specializations. 10.1532/hsf.1500
    [Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling?] Mamedkasimov N A,Spot E V,Alyaev Yu G,Rapoport L M,Sorokin N I Urologiia (Moscow, Russia : 1999) INTRODUCTION:our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. MATERIALS AND METHODS:a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+/-11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D-model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. RESULTS:In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+/-29.1 ml), than in patients with exophytic and endophytic tumors (142.3+/-15.2 and 208.2+/-35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+/-6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+/-5.2 min, p=0.005). The amount of blood loss was 179.4 +/- 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+/-87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. CONCLUSION:According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.
    Expanding the Indications of Robotic Partial Nephrectomy for Highly Complex Renal Tumors: Urologists' Perception of the Impact of Hyperaccuracy Three-Dimensional Reconstruction. Bertolo Riccardo,Autorino Riccardo,Fiori Cristian,Amparore Daniele,Checcucci Enrico,Mottrie Alexandre,Porter James,Haber Georges-Pascal,Derweesh Ithaar,Porpiglia Francesco Journal of laparoendoscopic & advanced surgical techniques. Part A OBJECTIVES:To assess the role of three-dimensional (3D) reconstruction in aiding preoperative planning for highly complex renal tumors amenable to robotic partial nephrectomy (RPN). MATERIALS AND METHODS:Computed tomography (CT) scans and respective 3D reconstructions of 20 highly complex renal tumors were displayed to the attendees/urologists of the 6th Techno-Urology Meeting ( www.technourologymeeting.com ). These 20 cases had already undergone RPN performed by a single experienced surgeon. The attendees were asked to watch the videos of the CT scans first, and then the respective 3D reconstructions of 5 of the 20 cases who were randomly selected. A purpose-built questionnaire collected responders' surgical experience and surgical indication (RPN versus nephrectomy) after viewing the CT scan and the respective 3D reconstructions. RESULTS:Twenty expert urologists, 27 young urologists, and 61 residents (total = 108) participated in the study. Five hundred forty-two views of the cases were obtained. Based on CT scans, RPN was indicated in 256 cases (47.2%). After viewing the respective 3D reconstructions, in 148 cases the responders changed their idea: indication to RPN raised in 404 cases (74.5%) (P < .001). The opinions changed regardless of the surgical experience. CONCLUSIONS:The findings of this study are encouraging, and they might represent a significant step toward the validation of the use of 3D reconstruction for surgical planning in patients undergoing robotic kidney surgery. The use of this technology might translate into a larger adoption of nephron-sparing approach. Further investigation in this area is warranted to corroborate these findings. 10.1089/lap.2018.0486
    Evaluation of three-dimensional printing for laparoscopic partial nephrectomy of renal tumors: a preliminary report. Zhang Yi,Ge Hong-wei,Li Ning-chen,Yu Cheng-fan,Guo Hong-feng,Jin Shi-hua,Liu Jin-shun,Na Yan-qun World journal of urology OBJECTIVES:To investigate the impact of three-dimensional (3D) printing on the surgical planning, potential of training and patients' comprehension of minimally invasive surgery for renal tumors. METHODS:Patients of a T1N0M0 single renal tumor and indicated for laparoscopic partial nephrectomy were selected. CT data were sent for post-processing and output to the 3D printer to create kidney models with tumor. By presenting to experienced laparoscopic urologists and patients, respectively, the models' realism, effectiveness for surgical planning and training, and patients' comprehension of disease and procedure were evaluated with plotted questionnaires (10-point rating scales, 1-not at all useful/not at all realistic/poor, 10-very useful/very realistic/excellent). The size of resected tumors was compared with that on the models. RESULTS:Ten kidney models of such patients were fabricated successfully. The overall effectiveness in surgical planning and training (7.8 ± 0.7-8.0 ± 1.1), and realism (6.0 ± 0.6-7.8 ± 1.0) were reached by four invited urologists. Intraoperative correlation was advocated by the two performing urologists. Patients were fascinated with the demonstration of a tactile "diseased organ" (average ≥ 9.0). The size deviation was 3.4 ± 1.3 mm. CONCLUSIONS:Generating kidney models of T1N0M0 tumors with 3D printing are feasible with refinements to be performed. Face and content validity was obtained when those models were presented to experienced urologists for making practical planning and training. Understandings of the disease and procedure from patients were well appreciated with this novel technology. 10.1007/s00345-015-1530-7
    Three-dimensional Printing and Augmented Reality: Enhanced Precision for Robotic Assisted Partial Nephrectomy. Wake Nicole,Bjurlin Marc A,Rostami Pooya,Chandarana Hersh,Huang William C Urology OBJECTIVE:To describe novel 3-dimensional (3D) printing and augmented reality (AR) methods of image data visualization to facilitate anatomic understanding and to assist with surgical planning and decision-making during robotic partial nephrectomy. MATERIALS AND METHODS:We created a video of the workflow for creating 3D printed and AR kidney models along with their application to robotic partial nephrectomy. Key steps in their development are (1) radiology examination (magnetic resonance imaging and computed tomography), (2) image segmentation, (3) preparing for 3D printing or AR, and (4) printing the model or deploying the model to the AR device. RESULTS:We demonstrate the workflow and utility of 3D printing and AR kidney models applied to a case of a 70-year-old woman with a 3.4 cm renal mass on her left pelvic kidney. A 3D printed kidney model was created using multicolor PolyJet technology (Stratasys J750), allowing a transparent kidney with coloring of the renal tumor, artery, vein, and ureter. An AR kidney model was created using Unity 3D software and deployed to a Microsoft HoloLens. The 3D printed and AR models were used preoperatively and intraoperatively to assist in robotic partial nephrectomy. To date, we have created 15 3D printed and AR kidney models to use for robotic partial nephrectomy planning and intraoperative guidance. The application of 3D printed and AR models is safe and feasible and can influence surgical decisions. CONCLUSION:Our video highlights the workflow and novel application of 3D printed and AR kidney models to provide preoperative guidance for robotic partial nephrectomy. The insights gained from advanced visualization can influence surgical planning decisions. 10.1016/j.urology.2017.12.038
    Three-dimensional printed model of bilateral Wilms tumor: A useful tool for planning nephron sparing surgery. Girón-Vallejo Óscar,García-Calderón Darío,Ruiz-Pruneda Ramón,Cabello-Laureano Rosa,Doménech-Abellán Ernesto,Fuster-Soler José Luis,Ruiz-Jiménez José I Pediatric blood & cancer Nephron sparing surgery (NSS) is increasingly utilized to treat patients with bilateral Wilms tumor. We present a case of NSS planning using a three-dimensional computerized and printed model of both kidneys with anatomical structures of interest (parenchyma, renal pelvis, major calyx, renal artery, renal vein, and tumor). This model allowed a better understanding of the anatomic relation between the tumor and the normal kidney on each side, improving the surgical planning and the preoperative discussion with the patient's family. 10.1002/pbc.26894
    Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images. Hyde E R,Berger L U,Ramachandran N,Hughes-Hallett A,Pavithran N P,Tran M G B,Ourselin S,Bex A,Mumtaz F H International journal of computer assisted radiology and surgery PURPOSE:To determine whether the interactive visualisation of patient-specific virtual 3D models of the renal anatomy influences the pre-operative decision-making process of urological surgeons for complex renal cancer operations. METHODS:Five historic renal cancer patient pre-operative computed tomography (CT) datasets were retrospectively selected based on RENAL nephrectomy score and variety of anatomy. Interactive virtual 3D models were generated for each dataset using image segmentation software and were made available for online visualisation and manipulation. Consultant urologists were invited to participate in the survey which consisted of CT and volume-rendered images (VRI) for the control arm, and CT with segmentation overlay and the virtual 3D model for the intervention arm. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered. RESULTS:Twenty-five participants were recruited (54% response rate), with 19/25 having > 5 years of renal surgery experience. The median anatomical clarity score increased from 3 for the control to 5 for the intervention arm. A change in planned surgical approach was reported in 19% of cases. Virtual 3D models increased surgeon confidence in the surgical decisions in 4/5 patient datasets. There was a statistically significant improvement in surgeon opinion of the potential utility for decision-making purposes of virtual 3D models as compared to VRI at the multidisciplinary team meeting, theatre planning, and intra-operative stages. CONCLUSION:The use of pre-operative interactive virtual 3D models for surgery planning influences surgical decision-making. Further studies are needed to investigate if the use of these models changes renal cancer surgery outcomes. 10.1007/s11548-019-01913-5
    Age-Related Renal Microvascular Changes: Evaluation by Three-Dimensional Digital Imaging of the Human Renal Microcirculation Using Virtual Microscopy. Uesugi Noriko,Shimazu Yoshihito,Kikuchi Kazunori,Nagata Michio International journal of molecular sciences The renal microvasculature is targeted during aging, sometimes producing chronic kidney disease (CKD). Overdiagnosis of CKD in older persons is concerning. To prevent it, a new concept of "healthy aging" is arising from a healthy renal donor study. We investigated the renal microcirculatory changes of three older persons and compared them with that of one patient with nephrosclerosis using a three-dimensional (3D) reconstruction technique that we previously developed. This method uses a virtual slide system and paraffin-embedded serial sections of surgical material that was double-immunostained by anti-CD34 and anti-α smooth muscle actin (SMA) antibodies for detecting endothelial cells and medial smooth muscle cells, respectively. In all cases, the 3D images proved that arteriosclerotic changes in large proximal interlobular arteries did not directly induce distal arterial change or glomerulosclerosis. The nephrosclerotic patient showed severe hyalinosis with luminal narrowing of small arteries directly inducing glomerulosclerosis. We also visualized an atubular glomerulus and intraglomerular dilatation of an afferent arteriole during healthy aging on the 3D image and showed that microcirculatory changes were responsible for them. Thus, we successfully visualized healthy aged kidneys on 3D images and confirmed the underlying pathology. This method has the ability to investigate renal microcirculatory damage during healthy aging. 10.3390/ijms17111831
    3D printed renal cancer models derived from MRI data: application in pre-surgical planning. Wake Nicole,Rude Temitope,Kang Stella K,Stifelman Michael D,Borin James F,Sodickson Daniel K,Huang William C,Chandarana Hersh Abdominal radiology (New York) OBJECTIVE:To determine whether patient-specific 3D printed renal tumor models change pre-operative planning decisions made by urological surgeons in preparation for complex renal mass surgical procedures. MATERIALS AND METHODS:From our ongoing IRB approved study on renal neoplasms, ten renal mass cases were retrospectively selected based on Nephrometry Score greater than 5 (range 6-10). A 3D post-contrast fat-suppressed gradient-echo T1-weighted sequence was used to generate 3D printed models. The cases were evaluated by three experienced urologic oncology surgeons in a randomized fashion using (1) imaging data on PACS alone and (2) 3D printed model in addition to the imaging data. A questionnaire regarding surgical approach and planning was administered. The presumed pre-operative approaches with and without the model were compared. Any change between the presumed approaches and the actual surgical intervention was recorded. RESULTS:There was a change in planned approach with the 3D printed model for all ten cases with the largest impact seen regarding decisions on transperitoneal or retroperitoneal approach and clamping, with changes seen in 30%-50% of cases. Mean parenchymal volume loss for the operated kidney was 21.4%. Volume losses >20% were associated with increased ischemia times and surgeons tended to report a different approach with the use of the 3D model compared to that with imaging alone in these cases. The 3D printed models helped increase confidence regarding the chosen operative procedure in all cases. CONCLUSIONS:Pre-operative physical 3D models created from MRI data may influence surgical planning for complex kidney cancer. 10.1007/s00261-016-1022-2
    Usefulness of personalized three-dimensional printed model on the satisfaction of preoperative education for patients undergoing robot-assisted partial nephrectomy and their families. Teishima Jun,Takayama Yukihiro,Iwaguro Shogo,Hayashi Tetsutaro,Inoue Shogo,Hieda Keisuke,Shinmei Shunsuke,Kato Ryoji,Mita Koji,Matsubara Akio International urology and nephrology OBJECTIVE:To clarify the usefulness of a personalized three-dimensional (3D) printed model of the kidney for preoperative education among patients who underwent robot-assisted partial nephrectomy (RAPN). METHODS:Twenty-nine cases of patients who planned to undergo RAPN and 19 of their families participated in this study. A three-dimensional model consisting of the kidney, tumors, ureter, inferior vena cava, and abdominal aorta in each case was generated using a Z Printer 450 based on the findings of preoperative enhanced CT. After preoperative education using enhanced CT and a 3D-printed model, two anatomy-related issues, three tumor-related issues, and two surgical procedure-related issues were evaluated using a visual analogue scale. RESULTS:The median age of all participants was 64 years old. The rate in male patients was significantly higher than that in families. In all three issues in patients and in two of three issues in families, scores in the 3D model were significantly higher than those in CT. In all issues in CT, scores of patients 64 years old or younger were higher than those of patients 65 years old or higher. On the other hand, no significant difference was found in the 3D model for scores on two of three issues regardless of the age of participants. CONCLUSION:Our data indicate that the personalized 3D printed model of the kidney is useful for preoperative education among patients and their families who underwent RAPN, especially in elderly people. 10.1007/s11255-018-1881-2
    Laparoscopic Partial Nephrectomy Supported by Training Involving Personalized Silicone Replica Poured in Three-Dimensional Printed Casting Mold. Golab Adam,Smektala Tomasz,Kaczmarek Krystian,Stamirowski Remigiusz,Hrab Michal,Slojewski Marcin Journal of laparoendoscopic & advanced surgical techniques. Part A BACKGROUND:Most kidney neoplasms are found incidentally and qualify for nephron-sparing surgery. Laparoscopic approach is beneficial to these patients because of its minimally invasive approach. However, these operations are both difficult and require plenty of experience and extended training. Some stages of the operation are limited by permissible time of transient ischemia. We applied three-dimensional (3D) printing technology to create individual silicone models of kidney to be used for training in laparoscopic procedures before the actual surgeries. MATERIALS AND METHODS:Three patients who qualified for laparoscopic partial nephrectomy were selected. Digital models of their kidneys with tumors were designed based on computed tomography scans, followed by creation of silicone models. These were cast into the forms printed in 3D. The proper surgery was preceded by an operation carried out in a silicone model of laparoscopic simulator in which the tumor was excised and lodged after tumorectomy was filled. RESULTS:Average time of the live kidney tumor operation was slightly shorter than that of the silicone model (16 versus 17 minutes). Relatively short period of ischemia did not exceed 9 minutes. One patient underwent surgery without closing the vascular pedicle. CONCLUSIONS:Experience gained during training with these silicone models improved the actual surgery and can reduce the need for/duration of intraoperative renal ischemia. We believe this training method can be successfully used in other procedures. 10.1089/lap.2016.0596
    Three-Dimensional Physical Model-Assisted Planning and Navigation for Laparoscopic Partial Nephrectomy in Patients with Endophytic Renal Tumors. Fan Gang,Li Jun,Li Mingfeng,Ye Mingji,Pei Xiaming,Li Feiping,Zhu Shuai,Weiqin Han,Zhou Xiao,Xie Yu Scientific reports Resection of completely endophytic renal tumors is a huge challenge for surgeons due to a lack of definite visual clues, especially in the laparoscopic approach. Three-dimensional (3D) kidney models, which can illustrate the clear relationship between renal masses and surrounding health tissues, were considered as reliable tools for understanding renal tumor characteristics in previous studies. We hypothesized that 3D kidney models can be used not only for planning but also for navigating laparoscopic partial nephrectomy (LPN) in patients with completely endophytic renal tumors. In this study, we successfully constructed five cases of 3D kidney models for assisted planning and navigation for LPN in endophytic renal tumors. The renal masses and surrounding normal parenchyma of the patient-specific 3D models were dyed by different colorants for clear illustration. All patients experienced acceptable perioperative outcomes, and no patient suffered serious relative complications. The 3D kidney models were considered as a reliable tool based on clinical outcome and postoperative questionnaire results. This study is the first report of 3D kidney models for patients with completely endophytic tumors. 3D kidney models can aid surgeons in understanding the characteristics of renal tumors and potentially support assisted planning and performance of LPN in endophytic tumor cases. 10.1038/s41598-017-19056-5
    [Application of 3D printing in urology]. Alyaev Yu G,Bezrukov E A,Fiev D N,Sirota E S,Pesegov S V,Byadretdinov I Sh Urologiia (Moscow, Russia : 1999) The purpose of this article is to outline the role and possible applications of 3D printing in urology. At present, this technique provides the opportunity to choose the individual strategy of patient management, to conduct preoperative planning and surgical rehearsal; for medical specialists to reduce the learning curve in mastering modern complex surgical techniques, and for doctors and students to improve understanding of pathological processes in the kidney and the prostate gland.
    The impact of three-dimensional tumor volume on cancer-specific survival for patients with pT1 clear-cell renal cell carcinoma. Song Wan,Jeong Byong Chang,Seo Seong Il,Jeon Seong Soo,Lee Hyun Moo,Choi Han Yong,Jeon Hwang Gyun World journal of urology PURPOSE:To evaluate the impact of three-dimensional tumor volume on cancer-specific survival for patients with pT1 clear-cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS:We reviewed a prospectively maintained database of 917 patients who underwent radical nephrectomy or nephron-sparing surgery for unilateral, pT1 ccRCC, including 654 pT1a and 263 pT1b patients, between April 1997 and December 2010. Three-dimensional tumor volume was measured using specialized volumetric software on cross-sectional computed tomography images of a preoperative venous phase. Kaplan-Meier and Cox regression analyses were carried out. RESULTS:The median age was 54 years with a follow-up of 60.8 months. Median tumor size and volume were 3.2 cm and 17.4 cm(3), respectively. Of 917 patients, 54 (5.9 %) had died, including 32 patients with ccRCC (9 patients in pT1a and 23 patients in pT1b). On multivariate analysis, tumor size >3.2 cm and tumor volume >17.4 cm(3) were associated with cancer-specific death in pT1 ccRCC patients. When stratified by pT1a/pT1b status and analyzed on median splits, tumor size >2.5 cm was associated with cancer-specific death but not tumor volume >9.5 cm(3) in pT1a patients. However, in pT1b patients, tumor volume >62.1 cm(3) (P = 0.036, HR 2.91, 95 % CI 1.02-7.77) was highly associated with cancer-specific death but not tumor size >5.0 cm (P = 0.159, HR 1.91, 95 % CI 0.78-4.70). CONCLUSIONS:In addition to tumor size, tumor volume is associated with cancer-specific death in pT1 ccRCC patients, particularly in pT1b ccRCC but not in pT1a ccRCC. 10.1007/s00345-015-1592-6
    Patient-specific 3-dimensional Printed Kidney Designed for "4D" Surgical Navigation: A Novel Aid to Facilitate Minimally Invasive Off-clamp Partial Nephrectomy in Complex Tumor Cases. Komai Yoshinobu,Sugimoto Maki,Gotohda Naoto,Matsubara Nobuaki,Kobayashi Tatsushi,Sakai Yasuyuki,Shiga Yoshiyuki,Saito Norio Urology OBJECTIVE:To report our initial experience with a novel style of 3-dimensional (3D) printed kidney, which we call "4D" surgical navigation in minimally invasive off-clamp partial nephrectomy (PN). MATERIALS AND METHODS:Ten patients with a R.E.N.A.L. nephrometry score ≥8 renal mass underwent minimally invasive off-clamp PN navigated with the aid of a patient-specific 3D printed kidney. To enhance the advantage of a 3D printed organ, we herein designed our 3D printed kidneys so that the tumor and its margin could be removed. This tumor removability allowed surgeons and patients to preoperatively visualize both the pre- and posttumor-resection kidney status, which we termed "4D" surgical navigation. Before patients consented to surgery, the surgical procedure and perioperative risks were explained to each patient using the patient-specific 3D printed kidney; subsequently, surgeons asked patients whether the 3D printed kidney model had helped them better understand their surgery than they would have without the model. RESULTS:All minimally invasive off-clamp PNs were successfully completed with acceptable perioperative outcomes and negative surgical margins. The 3D printed tumors together with their margins were nearly identical to the surgical specimens. All patients responded that their specific 3D printed kidney models had helped them understand their disease and the operations they underwent. CONCLUSION:This is the first report of a novel 3D printed organ style, which we termed "4D" surgical navigation. Use of the current 3D printed kidney models helped surgeons to perform minimally invasive off-clamp PN in complex tumor cases and also helped patients to more fully understand the operation. 10.1016/j.urology.2015.11.060
    Hyperaccuracy Three-dimensional Reconstruction Is Able to Maximize the Efficacy of Selective Clamping During Robot-assisted Partial Nephrectomy for Complex Renal Masses. Porpiglia Francesco,Fiori Cristian,Checcucci Enrico,Amparore Daniele,Bertolo Riccardo European urology BACKGROUND:Available technologies could avoid global ischemia for the removal of a renal tumor. OBJECTIVE:To present hyperaccuracy three-dimensional (HA3D) reconstruction during robot-assisted partial nephrectomy (RAPN) and compare its efficacy in sponsoring successful selective clamping of renal arterial branches during RAPN. DESIGN, SETTING, AND PARTICIPANTS:Patients undergoing RAPN (January 2016-July 2017) for renal mass PADUA score ≥10 who underwent abdominal computed tomography scan with angiography. Since February 2017 HA3D reconstruction was performed. SURGICAL PROCEDURE:HA3D reconstruction-aided RAPN and standard RAPN with selective clamping. MEASUREMENTS:Intraoperative variables focusing on the renal arterial pedicle management and success rate of its planned management. RESULTS AND LIMITATIONS:Thirty-one patients in group no HA3D and 21 in group HA3D. The median (standard deviation) tumor size was 50.9 and 50.8mm (p=0.97), and median PADUA scores 10.5 and 11 (p=0.85) for groups no HA3D and HA3D, respectively. In group no HA3D, a significantly higher number of patients underwent global ischemia (80% vs 24%, p<0.01). Of note, in 90% of the group HA3D cases, intraoperative management of the renal pedicle was performed as preoperatively planned; in 39% of the group no HA3D cases, management of the renal arterial pedicle was varied intraoperatively (p=0.04). We disclose the limited sample size and the experimental technique. CONCLUSIONS:Preoperative simulation of selective ischemia was feasible and effective with HA3D reconstruction. In all the RAPN cases performed, selective clamping was successful, avoiding ischemia of the healthy renal remnant. A strict collaboration between urologists and bioengineers is mandatory to improve the technology. PATIENT SUMMARY:In this report, we found that an accurate three-dimensional reconstruction of the kidney before conservative surgery for renal cancer seems to help in avoiding the global ischemia of the kidney. Further studies are needed to conclude if avoiding a percentage of ischemia to the kidney is clinically relevant. 10.1016/j.eururo.2017.12.027
    Personalized 3D printed model of kidney and tumor anatomy: a useful tool for patient education. Bernhard Jean-Christophe,Isotani Shuji,Matsugasumi Toru,Duddalwar Vinay,Hung Andrew J,Suer Evren,Baco Eduard,Satkunasivam Raj,Djaladat Hooman,Metcalfe Charles,Hu Brian,Wong Kelvin,Park Daniel,Nguyen Mike,Hwang Darryl,Bazargani Soroush T,de Castro Abreu Andre Luis,Aron Monish,Ukimura Osamu,Gill Inderbir S World journal of urology PURPOSE:To assess the impact of 3D printed models of renal tumor on patient's understanding of their conditions. Patient understanding of their medical condition and treatment satisfaction has gained increasing attention in medicine. Novel technologies such as additive manufacturing [also termed three-dimensional (3D) printing] may play a role in patient education. METHODS:A prospective pilot study was conducted, and seven patients with a primary diagnosis of kidney tumor who were being considered for partial nephrectomy were included after informed consent. All patients underwent four-phase multi-detector computerized tomography (MDCT) scanning from which renal volume data were extracted to create life-size patient-specific 3D printed models. Patient knowledge and understanding were evaluated before and after 3D model presentation. Patients' satisfaction with their specific 3D printed model was also assessed through a visual scale. RESULTS:After viewing their personal 3D kidney model, patients demonstrated an improvement in understanding of basic kidney physiology by 16.7 % (p = 0.018), kidney anatomy by 50 % (p = 0.026), tumor characteristics by 39.3 % (p = 0.068) and the planned surgical procedure by 44.6 % (p = 0.026). CONCLUSION:Presented herein is the initial clinical experience with 3D printing to facilitate patient's pre-surgical understanding of their kidney tumor and surgery. 10.1007/s00345-015-1632-2
    Current Use of Three-dimensional Model Technology in Urology: A Road Map for Personalised Surgical Planning. Porpiglia Francesco,Amparore Daniele,Checcucci Enrico,Autorino Riccardo,Manfredi Matteo,Iannizzi Giada,Fiori Cristian, European urology focus CONTEXT:Despite the current era of "precision surgery", an unmet need for an optimal surgical planning and navigation still remains for most genitourinary malignancies. In this setting, the 3D virtual reconstruction of 2D cross-sectional imaging has been increasingly adopted to facilitate the surgeon in better understanding the surgical anatomy. OBJECTIVE:To provide a short overview of the most recent evidences on the current applications of 3D virtual and printed reconstructions in urologic surgery. EVIDENCE ACQUISITION:A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use of 3D models in urology. EVIDENCE SYNTHESIS:3D reconstruction technology has been primarily implemented with the purpose of surgical planning and navigation, especially in the management of prostate and kidney cancer. Augmented reality is still in a rudimental phase, especially in the field of prostate cancer. The (poor) Literature already published suggests that the 3D virtual and printed models could be helpful for the comprehension and learning of the surgical strategy by the young urologists and, at the meantime, could enhance the quality of the dialog with the patients, giving them a direct perception of the disease and its treatment. CONCLUSION:Notwithstanding the current limitations and the sporadic experiences available in the Literature, 3D models technology is perceived as a useful tool for the surgical planning, especially in the field of kidney and prostate cancer, physician education/training and patient counselling. PATIENT SUMMARY:In the field of prostate and kidney cancer, the optimal surgical planning and the patient counselling seems to be improved by the use of 3D reconstruction technology based on the preoperative imaging. 10.1016/j.euf.2018.09.012
    Kidney cancer: A model for the masses--3D printing of kidney tumours. Stone Louise Nature reviews. Urology 10.1038/nrurol.2014.167
    [Application of 3D soft print models of the kidney for treatment of patients with localized cancer of the kidney (a pilot study)]. Alyaev Yu G,Sirota E S,Bezrukov E A,Fiev D N,Bukatov M D,Letunovskii A V,Byadretdinov I Sh Urologiia (Moscow, Russia : 1999) AIM:To evaluate the possibility of using 3D-printing in the management of patients with localized kidney cancer. MATERIALS AND METHODS:The study comprised five patients with localized kidney cancer who were treated at the Urology Clinic of the I.M. Sechenov First Moscow State Medical University from January 2016 to April 2017. Along with the standard examination, the patients underwent multispiral computed tomography (MSCT) to produce patient-specific 3D-printed models of the kidney tumors using 3D modeling and 3D printing. To evaluate the effectiveness of using 3D-printed models, two-stage preoperative planning was conducted, and five surgeons were surveyed using a four-question multiple choice questionnaire. At the first stage, the planning of operations was carried out based on MSCT findings. At the second stage, the surgeons were given patient-specific soft 3D models of the kidney with a tumor for preoperative training. After preoperative training, patients underwent laparoscopic resection of the kidney with a tumor. RESULTS:According to the survey results, each of the participating surgeons at least once changed surgical plan based on data obtained with 3D printed models of the kidney with the tumor. The implementation of preoperative training using 3D printed models of the kidney turned out to be effective. All patients underwent laparoscopic surgery performed by a single surgeon with extensive experience in this type of surgery. The mean operative time was 187 minutes. All operations were performed with main renal artery occlusion. The men warm ischemia time was 19.5 minutes and the mean blood loss was 170 ml. There were no conversions to open surgery and organ-removing operations. There were no postoperative complications or deaths. All surgical margins were negative. Morphological examination showed that four patients had renal cell carcinoma one patient had the oncocytoma. CONCLUSION:The study demonstrated the promise of using 3D printing for preoperative planning and surgical performance due to a high-precision three-dimensional soft patient-specific model of the localized kidney.
    Three-dimensional reconstruction volume: a novel method for volume measurement in kidney cancer. Durso Timothy A,Carnell Jonathan,Turk Thomas T,Gupta Gopal N Journal of endourology BACKGROUND AND PURPOSE:The role of volumetric estimation is becoming increasingly important in the staging, management, and prognostication of benign and cancerous conditions of the kidney. We evaluated the use of three-dimensional reconstruction volume (3DV) in determining renal parenchymal volumes (RPV) and renal tumor volumes (RTV). We compared 3DV with the currently available methods of volume assessment and determined its interuser reliability. PATIENTS AND METHODS:RPV and RTV were assessed in 28 patients who underwent robot-assisted laparoscopic partial nephrectomy for kidney cancer. Patients with a preoperative creatinine level of <1.2 mg/dL with available scans were selected. RPV and RTV were then assessed using 3DV, as well as cylindrical approximation for RPV and spherical approximation for RTV as described previously in the literature. Measures of the same quantity from each method were then compared. In addition, interuser reliability was determined for 3DV. RESULTS:Calculated volumes differed widely in comparison with 3DV. For example, cylindrical volumes for the contralateral kidney pre- and postsurgery overestimated 3D reconstruction volumes by 15% to 102% and 12% to 101%, respectively. In addition, volumes obtained from 3DV displayed high interuser reliability regardless of experience. CONCLUSIONS:3DV provides a highly reliable way of assessing kidney volumes. Given that 3DV takes into account visible anatomy, the differences observed using previously published methods can be attributed to the failure of geometry to accurately approximate kidney or tumor shape. 3DV provides a more accurate, reproducible, and clinically useful tool for urologists looking to improve patient care using analysis related to volume. 10.1089/end.2013.0796
    Multiple application of three-dimensional soft kidney models with localized kidney cancer: A pilot study. Glybochko Peter Vitalevich,Rapoport Leonid Mikhailovich,Alyaev Yuri Gennadevich,Sirota Eugene Sergeevich,Bezrukov Eugene Alexeevich,Fiev Dmitry Nikolaevich,Byadretdinov Ildar Shamilevich,Bukatov Mikhail Dmitrievich,Letunovskiy Alexander Vasilevich,Korolev Dmitry Olegovich Urologia AIM:To evaluate the effectiveness of three-dimensional printing application in urology for localized renal cancer treatment using three-dimensional printed soft models. MATERIALS AND METHODS:The study included five patients with kidney tumors. The patients were treated in the Urology Clinic of I.M. Sechenov First Moscow State Medical University from February 2016 to June 2017. Personalized three-dimensional printed models based on computed tomographic images were created. Five surgeons took part in a survey in which the utility of computed tomographic images versus three-dimensional printed models for presurgical planning was compared. A laparoscopic partial nephrectomy training using the developed three-dimensional printed models was performed by the same surgeons in a surgical training box. RESULTS:The patients underwent endoscopic surgery using laparoscopic access. The average time of surgery was 187 min. All the operations were performed with complete renal artery clamping. The average warm ischemia time was 19.5 min and the average blood loss was 170 mL. No conversions to open surgery or radical nephrectomy, and no postoperative complications and deaths were observed. All the surgical margins were negative. The tumors were morphologically identified as renal cell carcinoma in four cases and as oncocytoma in one case. CONCLUSION:The developed three-dimensional printed models allow one to evaluate the pathological anatomy of tumors more effectively. High similarity between three-dimensional models and native kidneys contribute to improvement of surgical skills necessary for partial nephrectomy. Training on the three-dimensional models also allows surgeons to facilitate selection of an optimal surgical tactics for each patient. 10.1177/0391560317749405