Zero-ischemia robotic and laparoscopic partial nephrectomy, a novel concept, eliminates ischemia to the tumor-free normal kidney. Anatomic microdissection of tertiary/higher-order tumor-specific arteries is performed to selectively devascularize only the tumor, maintaining normal perfusion of the remaining kidney. A thorough understanding of renovascular tumor anatomy is essential. Based on 0.5-mm-slice thickness computed tomography scans, we developed a novel three-dimensional (3D) reconstruction technique that fuses three key anatomic aspects: surface-rendered tumor, semitransparent kidney, and extra- and intrarenal arterial anatomy. Four central completely intrarenal hilar masses underwent 3D reconstruction for surgical navigation during zero-ischemia partial nephrectomy. Negative surgical margins were obtained in all four cases, with no intraoperative complications or transfusions. For these challenging laparoscopically invisible masses, 3D image navigation precisely identified tumor-specific arterial branches, thus facilitating zero-ischemia partial nephrectomy without hilar cross clamping. © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Ukimura, O., Nakamoto, M., & Gill, I. S. (2012). Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy. European Urology. Elsevier B.V. https://doi.org/10.1016/j.eururo.2011.07.068