3D virtual reconstruction: usefulness in preoperative planning for oncologic renal surgery in children

Abstract

Preoperative planning for complex pediatric renal masses can be challenging, especially when nephron-sparing surgery (NSS) is recommended. We report our experience using 3D virtual reconstruction (3DVR) and its impact on surgical decision making. Patients with complex renal masses underwent preoperative 3DVR after acquisition and segmentation of DICOM data obtained from abdominal MRI and/or CT scan. A questionnaire divided into two phases, pre- and post-operatively, was completed by the surgeons and the radiologist involved. The aim was to evaluate the quality of the use of 3DVR compared to conventional imaging. 8 patients (4♂,4♀) were included. A total of four radical nephrectomies and three NSS were performed. Compared to conventional imaging, the 3DVR models were judged to be superior for all anatomical structures (Tumor/Arteries/Veins p < 0.0001) except for the urinary tract ( p = 0.0888). 3DVR was also found to be more effective in the definition of elective criteria for NSS ( p = 0.0003) and is a fundamental tool for surgeons as the images are easy to use during surgery in comparison to conventional images ( p = 0.0006). Our study suggests that 3DVR is a useful tool in preoperative evaluation of children with complex renal masses, facilitating NSS in selected patients.