Construction Of SIREN Scoring System And Its Clinical Significance Of Robot-assisted Laparoscopic Partial Nephrectomy

Objective: Based on three-dimensional reconstruction technology,the system of individualized reno-vasculature evaluation for nephrectomy(SIREN)is used to accurately describe the anatomical characteristics of blood vessels in the pending vascular operation area to be treated during robot-assisted laparoscopic partial nephrectomy(RALPN).To discuss the application effect of SIREN scoring system in RALPN.Methods: A retrospective analysis was performed on 84 patients who underwent RALPN at the First Hospital of Shanxi Medical University from October 2017 to February 2020.Threedimensional reconstruction of the CT image data of the patients was performed.Observe and measure the three-dimensional reconstruction model to obtain the specific and crucial arteriovenous anatomical features were recorded,which consist of side,count,spatial configuration and density of the vessel to be processed,and perform SIREN scoring system on them.Obtain R.E.N.A.L.score and PADUA score by observing CT images.Review the surgical video for vascular treatment time.According to the presence or absence of vascular correlation events(VCE)and vascular treatment time during operation,they were divided into simple group(no VCE,vascular treatment time≤30min)and difficult group(VCE,vascular treatment time>30min).Univariate analysis compared the gender,age,BMI,ASA score,CCI score,RANAL score,PADUA score,and SIREN score between the two groups.Multivariate analysis was used to obtain the predictive effect of SIREN score on the difficulty of intravascular treatment.Results: Of the 84 subjects,56 were male(66.7%)and 28 were female(33.3%).The median age was 58(IQR: 51-69)and the median BMI was 24.4 Kg/m2(IQR: 23.4-27),54 cases in the simple group and 30 cases in the difficult group.Through univariate analysis,there was no significant difference in gender,age,BMI,CCI score,ASA score,R.E.N.A.L.score,and PADUA score between the general group and the difficult group(P>0.05);The difference in SIREN score was statistically significant(P<0.05).Multivariate analysis found that the SIREN score had a good predictive effect on the most difficult PVOA vascular management during RALPN surgery(O.R.1.364,95% C.I.0.972 to 5.003,P <0.001).Conclusion: The SIREN scoring system can accurately predict the difficulty of vascular treatment in the operation area of the vessel to be treated during RALPN,which is helpful for good preoperative planning and optimization of the surgical plan.