Application Of Three-dimensional Angiography In Robotic Assisted Laparoscopic Partial Nephrectomy

Background:In recent decades,the incidence of renal tumors showed a rising trend year after year which made it a common urological tumor.With the improvement of people’s awareness of health and the constant update of examination equipment,more and more T1 tumors were detected.The development of surgical minimally invasive techniques,especially the application of robot assisted surgery system made partial nephrectomy been accepted as the best surgical method for T1 tumors by more and more scholars.For partial nephrectomy,a full understanding of the anatomy of the kidney,especially the vascular structure,is the foundation to complete the operation safely.It is also the key to selecting the operation plan more rationally,improving the surgical skills as well as improving the life quality of our patients.Owning to the variability of renal vascular,the traditional CT and MRI examination could not show the renal vascular structure clearly which affected the safety of the operation.However,with the advancement of imaging technology,the application of three-dimensional renal angiography based on CTA enabled surgeons to observe the variation of renal vessels and relationship between the tumor,blood vessel and the collecting system.As a result,it can greatly enhance the preoperative assessment result and improve the safety of surgery.Objective:To investigate the applicational value of three-dimensional angiography in the evaluation of renal artery variation before robotic assisted laparoscopic partial nephrectomy(RALPN)and its significance.And to investigate the value of three-dimensional angiography in robotic assisted laparoscopic partial nephrectomy based on the perioperative statistics.Methods:Clinical statistics of patients who had undertaken robotic assisted laparoscopic partial nephrectomy in our hospital were retrospectively reviewed from January 2015 to February 2017,including their gender,age,BMI,location,diameter and other perioperative statistics.All patients were enrolled based on rigorous including and excluding criteria.1.We choose patients who have done CTA preoperatively to assess the variability of renal vascular.General information such as gender,age,BMI,tumor location,maximum tumor size and postoperative pathological results were recorded.We classified the statistics according to the variation of the location of the renal artery,the variation of the number of the renal artery and the variation of the origin of the renal artery.2.The above patients were divided into groups according to whether CTA examination was performed or not and the patients were divided into groups more precisely according to different surgical procedures.General information such as gender,age,BMI,tumor location,tumor diameter and postoperative pathological results were recorded.The perioperative data including OT,EBL,WIT were recorded and analysed.Results:1,300 patients were enrolled and the CTA examinations were successfully completed without any complications.The total variation rate of renal artery was 40.2%.The variation rate of left,right and both renal artery was 37.4%,42.9%and 19.7%,but there was no significant difference in location.79.5%of the kidneys had one renal artery,however the incidence of number variation of renal artery was significantly higher in male than in female.The incidence of accessory renal artery was 37.1%and 68.2%of them travelled to the upper or lower pole of the kidney.2.A total of 564 cases were enrolled in the study which included 300 cases of preoperative CTA examination and 264 cases of routine imaging examination.All patients underwent robotic assisted laparoscopic partial nephrectomy which contained 295 cases of transabdominal approach and 269 cases of retroperitoneal approach.There was no significant difference in age and tumor diameter between the two groups.No matter whether it was transabdominal or retroperitoneal approach,the warm ischemia time of the CTA group was significantly less than that of the routine examination group,but there was no significant difference in operation time,estimated blood loss and surgical margin.Conclusions:1.The three-dimensional angiography can clearly show the variation of renal artery,which will enrich the content and improve the efficacy of preoperative evalution.It can provide surgeons with abundant information and as a result,could be used as a routine examination of RALPN preoperatively.2.Preoperative three-dimensional angiography examination can effectively shorten the warm ischemia time and to some extent reduce the amount of estimated blood loss of robot-assisted laparoscopic partial nephrectomy,which will greatly improves the safety of surgery and provide more effective protection for patient’s life and health.