The planning, simulating and executing for the surgery of bilateral renal masses used the three-dimensional intelligent qualitative and quantitative analysis system(IQQA)

Objective To explore the application of three-dimensional intelligent qualitative and quantitative analysis system (IQQA) in the planning, simulation and implementation of precise surgery for bilateral renal tumors. Methods A retrospective analysis a total of 7 patients with bilateral kidney tumors in our center from June 2017 to August 2018 was performed. There were 5 males and 2 females, with an average age of (54.6±6.0)years , ranging 47.0-63.0 years. The average BMI index was (23.4±2.4) kg/m2, ranging 21.2-28.0 kg/m2. The average diameter of 14 renal tumors in 7 patients was (3.8±1.1) cm, ranging 1.9-5.3 cm. The average R. E.N.A.L score was 6.6±1.2 , ranging 5.0-9.0. The tumor stage was T1N0M0. The mean preoperative hemoglobin, albumin, creatinine and GFR were (138.6±17.0)g/L and (47.3±2.5 g/L), (51.6±19.1)μmol /Land (56.9±6.7)ml/min, respectively. Before operation, the original data of CT were input into IQQA system. Then we reconstructed kidney, blood vessel, collecting system and tumors using system. And the structure of kidney, tumors and vessels was visualized directly. The systematic analysis of the operation is carried out at terminals vary from various angles, and the surgical resection simulation. The position, angle and curvature of the cut surface are adjusted according to the effect. The plan of partial nephrectomy is designed. The resection area, remaining area of kidney is calculated. In this way, we can construct individualized and accurate laparoscopic partial nephrectomy planning before operation. Last, we carried out the operation according to the designed plan. The laparoscopic standard partial nephrectomy was performed in 11 cases. The laparoscopic selective partial nephrectomy was performed in 2 cases. One underwent laparoscopic partial nephrectomy without obstruction. We achieved precise resection of tumors and rapid suture of wounds according to the preoperative planning of excision and suture. We collected of the surgical success rate, conversion to opening rate, operation time, warm ischemia time, intraoperative bleeding volume, complications and hospitalization after operation. The related laboratory indicators such as eGFR and creatinine were followed up for 3 months, and the prognostic indicators such as renal CT and pulmonary CT for 6 months after operation were evaluated and analyzed. Result 14 renal tumors were successfully reconstructed by IQQA in 7 patients. The operations were completed successfully without conversion to open surgery or radical nephrectomy. The average operative duration was (68.9±9.2) minutes, ranging 50.0-80.0 minutes. The average renal artery occlusion duration was (20.7±4.1) minutes, ranging 15.0-29.0 minutes. The average intraoperative bleeding volume was (70.7±29.7) ml, ranging 30.0-120.0 ml. The average indwelling time of drainage tube was (5.5±0.7) days, ranging 5.0-7.0 days. The average hospitalization time was (6.3±0.5) days, ranging 6.0-7.0 days. There were no perioperative complications such as bleeding, urinary leakage, infection, incision dehiscence and pulmonary infection. Postoperative pathology revealed 13 clear cell renal carcinoma and 1 renal angiomyoma. No recurrence or metastasis was found in chest CT and lung CT after 6 months follow-up. The creatinine and GFR in 3 months after operation were (52.0±15.2)μmol/L(36.0-72.0 μmol/L)and (56.7±5.3)ml/min(46.7-66.3 ml/min). There was no significant difference of creatinine and GFR with the preoperative (P>0.05). The mean Hb and albumin levels in 3 months after operation were (120.9±17.0)g/L(90.0-147.0 g/L) and (41.4±2.6)g/L(38.0-46.0 g/L), which were significantly lower than those before operation (P<0.05). Conclusions The three-dimensional intelligent qualitative and quantitative analysis system (IQQA) can visualize the kidney, tumor and the vasculature of bilateral kidney tumors by preoperative three-dimensional reconstruction. The optimal surgical plan of partial nephrectomy can be designed by preoperative operation planning and computer terminal in order to enhance the safety of partial nephrectomy for bilateral kidney tumors and preserve the possibility of kidney, and protect the renal function to the greatest extent. To accurately predict the retention of renal function after operation, so that patients with bilateral renal tumors can get the greatest benefit in partial nephrectomy. Key words: Bilateral renal tumors; Intelligent qualitative and quantitative analysis; Laparoscopic partial nephrectomy; Surgical planning