UROLOGICAL SURVEY   ( Download pdf )

 

ENDOUROLOGY & LAPAROSCOPY

Kidney displacement simulator for retroperitoneal laparoscopic nephrectomy
Takiuchi H, Mori Y, Shima H, Tanooka M, Hirayama S, Nakao N
Division of Urology, Nishinomiya Municipal Central Hospital, Hyoga, Japan
J Urol. 2005; 174: 2111-4

  • Purpose: We evaluated the efficacy of a renal displacement simulator originally developed at our department for retroperitoneal laparoscopic nephrectomy.
  • Materials and Methods: A total of 12 patients with a malignant localized renal (7) or ureteral (5) neoplasm underwent multidetector row computerized tomography. Imaging data were sent to a dedicated work station to create volume rendering and virtual laparoscopic images of the kidney, which was displaced ventral using a retroperitoneal balloon. These findings were compared with video images obtained during laparoscopy surgery.
  • Results: The kidney displacement simulator depicted all renal arteries (100% sensitivity) and 13 of 14 renal veins (93% sensitivity). Hilar anatomy, including the tumor, as well as major vessels and their relationships were visualized by the simulator in the laparoscopic views. The major vessel portions completely corresponded to those seen during surgery, and the left adrenal and gonadal veins were also synchronized quite well.
  • Conclusions: Our kidney displacement simulator was able to visualize the major vessel portions and branched small vessels, such as the adrenal and gonadal veins, prior to surgery. It is considered useful for providing guidance to surgeons and decreasing operative risks and possible complications.

  • Editorial Comment
    Due to new regulations and complexity of surgical procedures, new training tools are demanded for better understanding of surgical steps and schooling of dexterity for development of surgical skills. This study combines pre-operative imaging technique with the laparoscopic procedure allowing identifying several anatomical landmarks, particularly the vascular structures allowing surgeons to carefully plan the surgical steps minimizing possible complications. It is possible that in the future a software will allow pre-planned surgeries to be performed prior to the actual procedure, as well as for training purpose.

Dr. Fernando J. Kim
Chief of Urology, DHMC
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA