EAU 2018: Combined Use of 3D Reconstruction Plus Near-Infrared Fluorescence During Robot-Assisted Partial Nephrectomy for Pt1b Tumors
Dr. Mattevi from Santa Chiara Hospital Department of Urology in Trento, Italy presented a retrospective analysis of 60 consecutive patients undergoing RAPN from January 2017 to July 2017. Because there were only three cases in which NIRF imaging and 3D reconstruction were used, it is noted that the sample size did not allow rigorous statistical analysis or adjustment for patient- or surgeon- dependent characteristics.
Surgical planning via 3D reconstructions were obtained from CT scan images 2 weeks before surgery. In discussion, Dr. Mattevi recalls the logistic challengers of obtaining these 3D reconstructions – despite the actual process only taking approximately 20 minutes, the technician office was located off-site and coordination was of large difficulty.
Of the three cases in which NIRG imaging and 3D reconstruction were used, selective clamping as guided by 3D reconstruction was utilized in 2 cases and super selective clamping as guided by NIRF imaging was utilized in 1 case.
Both the 3DNIRG and S-RAPN groups had a PAUA score of 11, but median tumor diameter was 50mm and 50mm, respectively No major complications were reported in the 3D NIRG-RAPN group, in stark contrast to the 3 acute hemorrhage with embolization found in the S-RAPN group. Further, there was a greater loss of renal function observed in the S-RAPN group as compared to the NIRF-RAPN group. Total renal function change at 1 month post-procedure was -8% and +14% in the S-RAPN versus 3DNIRG groups.
While the current study represents a novel pilot study of 3D reconstruction in RAPN, it yields highly promising results for the use of 3D NIRGF for high complexity pT1b tumors and is of benefit when used in the context of guiding selective or super-selective clamping. Once the current study is expanded to a larger and more diverse patient population, however, surgeon-dependent and tumor-related characteristics may impact the favorability of these results. Additionally, trade-offs in logistic coordination and cost-effectiveness (whether in super-selected populations or as a routine offering) should be considered.
Presented by: Mattevi D, MD Santa Chiara Hospital, Dept. of Urology, Trento, Italy
Co-Authors: Luciani L.G., Chiodini S., Puglisi M., Valentino V. , Tiscione D., Malossini G., Santa Chiara Hospital, Dept. of Urology, Trento, Italy
Written by: Linda M. Huynh, BS, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark