Dr. José Antonio Bellido Petti
Hospital General de Vic - Barcelona, España
Benefits
✔ Increased understanding of complex anatomy
✔ Change of surgical plan
✔ Reduction of ischaemia time
✔ Reduced bleeding
✔ Significant savings in supplies
✔ Guidance in the surgical approach within the operating room
Clinical case
A 65-year-old male patient, smoker and hypertensive.
A CT scan detected two abnormal masses in his kidneys. They corresponded to a renal tumour in the right kidney and a cyst in the left kidney.
Surgical plan and outcome in the operating room
Initially, a partial nephrectomy was to be performed to treat the patient, but with the use of the 3D model the surgical strategy chosen was a lumpectomy, i.e. tumour enucleation with selective arterial clamping. The intervention therefore meant that less renal parenchyma was removed and thus a faster recovery of renal function. A more conservative approach brings not only the above-mentioned benefits for the patient, but also a saving in consumables due to the smaller amount of suturing required.
The procedure was performed transperitoneally laparoscopically and only the tumour was removed as the cyst in the right kidney was benign.
The virtual 3D model that Dr Bellido had for his surgical planning was key to perfectly understand the atypical anatomy of the patient who had an early bifurcation of the posterior renal artery. This gave the surgical team the possibility of selective clamping of an artery. Consequently, the ischaemia time, which lasted 13 min, was reduced, and the total surgery time was reduced to 76 min.
In turn, the biomodel was used as a guide in the operating room, allowing a reduction in bleeding due to the control of the vessels already located beforehand. This means that the patient does not require a blood transfusion, achieving benefits for the patient and for the institution by saving the cost of the transfusion, which is currently around 900 euros.
Finally, the surgery was successfully performed and the pathological anatomy showed that the removed mass corresponded to a clear cell renal tumour, Fuhrman 2 , with negative margins of 3.6 centimetres.
"It has been a really nourishing experience to be able to count on 3D reconstruction that has allowed us a selective arterial clamping, in a surgery with a kidney with an unusual vascular alteration, which resulted in a shorter surgical time, less bleeding and faster recovery" Dr. Bellido Petti comments
You may be interested in: "3D Urology: Biomodel-guided nephrectomy and lymphadenectomy", where Dr. Hevia used 3D models to guide a radical nephrectomy + lymphadenectomy and allowed for a simpler, faster and more precise procedure.