Application Value Of Holographic Image Precision Surgery Planning In Nephron-sparing Surgery For Renal Tumor

Objective:By analyzing the application of holographic in laparoscopic nephron-sparing surgery and explore the advantage of holographic image precision surgery planning in the treatment of renal tumors,which will provide certain help and guidance value of nephron-sparing surgery for renal tumors.Methods:From January 2018 to December 2019,a total of 67 patients with cT1 renal tumors who underwent laparoscopic nephron-sparing surgery in our hospital were analyzed retrospectively.All the cases had preoperative examinations plain CT of the middle and lower abdomen and contrast-enhanced scanning.The patients were divided into holographic image group and CT group according to whether who received holographic image precision surgery planning.The holographic imaging group refers to the construction of a three-dimensional model of renal tumor by the holographic 3d reconstruction system for preoperative planning.During the operation,the holographic laparoscopic fusion system is used to fuse the three-dimensional model of renal tumor with the surgical image to guide the operation,while the CT group completes the operation under the traditional CT image planning.A total of 31 patients in the holographic image group,including 21 males(68%)and 10 females(32%),mean age(52.4 ± 13.1)years old,greatest tumor diameter(3.8 ± 1.0)cm,tumor TNM stage,20 cases of T1aN0M0 stage(65%),11 patients(35%)in T1bN0M0 stage,the mean R.E.N.A.L score was(7.0 ± 1.5).There were 36 patients in the CT group,including 17 males(47%)and 19 females(53%),age(50.7 ± 14.7)years old,greatest tumor diameter(3.6 ± 1.1)cm,tumor TNM stage,28 T1aN0M0cases(78 %),8 cases(22%)of T1bN0M0 stage,the mean R.E.N.A.L score was(6.4± 1.3).By comparing the preoperative data and the results of the two groups of patients whether statistical significance,application value of holographic image precision surgery planning in nephron-sparing surgery of renal tumor was analyzed.Results:Both groups of operation were successfully completed surgery,without case conversion to open surgery or death during operation.According to statistical analysis,although the holographic image group had the operation time(106.5 ± 21.1 versus122.7 ± 30.1,P = 0.066),warm ischemia time(23.5 ± 6.1 versus 25.3 ± 5.1,P =0.420),and intraoperative blood loss(104.2 ± 36.3 versus 115.0 ± 40.6,P = 0.069),intraoperative collective system injury rate [2(6%)versus 8(22%),P = 0.071],postoperative hemoglobin changes(10.4 ± 3.3 versus 12.5 ± 2.9,P = 0.938),postoperative serum creatinine changes(16.7 ± 5.5 versus 17.2 ± 10.3,P = 0.067),Postoperative urinary leak rate [0(0%)versus 1(2.8%),P = 1.000],postoperative drainage tube removal time(4.2 ± 0.7 versus 4.4 ± 0.8,P = 0.141)and postoperative hospitalization time(6.1 ± 0.8 versus 6.5 ± 0.8,P = 0.626)were lower than the CT group,but the results were not statistically significant(P> 0.05).However,in the subgroup analysis of complex renal tumors with RENAL score ?7,the operation time of holographic image group(117.8 ± 21.3min versus 146.6 ± 40.5min,P = 0.035)and the rate of intraoperative collective system injuries [1(6.3%)versus 6(50%),P =0.023] between the two groups are of statistical significance(P<0.05).Conclusion:This study demonstrated that the use of the holographic image precision surgery planning system,the construction of the three-dimensional model of renal tumors in the preoperative,and real-time navigation during surgery provide reliable guidance in nephron-sparing surgery for renal tumor.The technology has remarkable advantage especially in the operation of complex renal tumors with high R.E.N.A.L scores.