Clinical Consultation GuideThree-dimensional Printing for Renal Cancer and Surgical Planning
Introduction
Partial nephrectomy (PN) is the standard management for T1a renal masses, an accepted option for T1b masses, and may be considered for lesions ≥cT2 when there are absolute or relative indications for renal preservation [1]. Compared to radical nephrectomy (RN), PN has been associated with greater preservation of renal function and an overall survival advantage [2]. Thus, the relevant surgical principles for optimizing PN-specific outcomes are maximization of parenchymal preservation and minimization of ischemia time. However, complex renal anatomy or tumor characteristics may increase PN difficulty and compromise outcomes. Therefore, there is a need for new technologic developments to optimize the planning and execution of complex renal surgery. Three-dimensional (3D) digital reconstructions of renal and tumor anatomy from Digital Imaging and Communications in Medicine (DICOM) images are limited by the need to view them on a two-dimensional (2D) screen. However, 3D printed models generated from DICOM images provide both tactile feedback and anatomic information that can be incorporated in preoperative planning for complex surgical operations [3].
Section snippets
Basics of 3D printing
3D stereolithographic models can be printed from any volumetric image data set that has sufficient contrast to differentiate tissues [3]. Images from computed tomography (CT) are most commonly used because of the wide spectrum of applications and relative ease of image post-processing, although magnetic resonance imaging (MRI) and rotational fluoroscopy can also be used [3]. After data acquisition, segmentation is performed by identifying and marking structures of interest (Fig. 1A). Next,
Current role of 3D printing in urology
The most common urologic operation in which 3D printing is used is PN because of the importance of understanding the hilar anatomy and location of the tumor [3]. In our practice, we have used 3D models for patients with complex vascular anatomy (ie, duplicated inferior vena cava [IVC] or multiple aberrant vessels), renal anomalies (horseshoe kidney), baseline renal insufficiency in the setting of a functional solitary kidney, and large renal masses. For example, a 53-yr-old male with poorly
Future directions and conclusions
With the emergence of PN as the favored approach for management of pT1 renal masses, and even pT2 renal masses when technically feasible, there has been increasing interest in developing aids for planning of complex renal surgery. 3D stereolithographic models may significantly enhance successful performance of complex nephron-sparing surgery, although additional studies are needed to quantify the improvements in surgical outcomes. This technology has the potential to alter preoperative surgical
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Three-Dimensional Printing in Urology: History, Current Applications, and Future Directions
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Outcomes of Nephron-sparing Surgery in T1 vs T2 Renal Tumours
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