Role of the three-dimensional printing technology incomplex laparoscopic renal surgery: a renal tumor in a horseshoe kidney

Horseshoe kidney: Morphologic features, embryologic and genetic etiologies, and surgical implications

The horseshoe kidney (HSK) is the most common congenital abnormality of the upper urinary tract with an incidence of approximately 1 in 500 in the general population. Although individuals with HSK are often asymptomatic, they are at increased risk for neoplasms, infections, ureteropelvic obstruction secondary to lithiasis or vascular compression. Direct injury from trauma is increased in these individuals as is the risk of intraoperative complications secondary to damage involving the typically complex renal or adrenal vascular supply. We briefly review etiological factors including renal and urinary system embryology, genetic mutations, abnormalities related to faulty cell signaling, aberrant cell migration, and other possible causes including environmental exposures and trauma. In addition, we call attention to factors that might influence the success of surgical procedures in patients with HSK. We argue that an understanding of possible etiologies of the HSK and its different subtypes may be useful when planning surgical procedures or considering risk-benefit ratios associated with different surgical options. We briefly present the organization of a HSK in a 100-year-old male demonstrating an unusual vascular supply discovered during a dissection laboratory session in a medical school anatomy course. We describe the structure of the HSK, the position and relationships of the HSK to other structures within the abdomen, and the associated vascular relationships.

The Progress in Bioprinting and Its Potential Impact on Health-Related Quality of Life

The intensive development of technologies related to human health in recent years has caused a real revolution. The transition from conventional medicine to personalized medicine, largely driven by bioprinting, is expected to have a significant positive impact on a patient's quality of life. This article aims to conduct a systematic review of bioprinting's potential impact on health-related quality of life. A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, Google Scholar, and ScienceDirect databases between 2019 and 2023. We have identified some of the most significant potential benefits of bioprinting to improve the patient's quality of life: personalized part production; saving millions of lives; reducing rejection risks after transplantation; accelerating the process of skin tissue regeneration; homocellular tissue model generation; precise fabrication process with accurate specifications; and eliminating the need for organs donor, and thus reducing patient waiting time. In addition, these advances in bioprinting have the potential to greatly benefit cancer treatment and other research, offering medical solutions tailored to each individual patient that could increase the patient's chance of survival and significantly improve their overall well-being. Although some of these advancements are still in the research stage, the encouraging results from scientific studies suggest that they are on the verge of being integrated into personalized patient treatment. The progress in bioprinting has the power to revolutionize medicine and healthcare, promising to have a profound impact on improving the quality of life and potentially transforming the field of medicine and healthcare.

Survey of methods and principles in three-dimensional reconstruction from two-dimensional medical images

Three-dimensional (3D) reconstruction of human organs has gained attention in recent years due to advances in the Internet and graphics processing units. In the coming years, most patient care will shift toward this new paradigm. However, development of fast and accurate 3D models from medical images or a set of medical scans remains a daunting task due to the number of pre-processing steps involved, most of which are dependent on human expertise. In this review, a survey of pre-processing steps was conducted, and reconstruction techniques for several organs in medical diagnosis were studied. Various methods and principles related to 3D reconstruction were highlighted. The usefulness of 3D reconstruction of organs in medical diagnosis was also highlighted.

Additive Manufacturing of 3D Anatomical Models-Review of Processes, Materials and Applications

The methods of additive manufacturing of anatomical models are widely used in medical practice, including physician support, education and planning of treatment procedures. The aim of the review was to identify the area of additive manufacturing and the application of anatomical models, imitating both soft and hard tissue. The paper outlines the most commonly used methodologies, from medical imaging to obtaining a functional physical model. The materials used to imitate specific organs and tissues, and the related technologies used to produce, them are included. The study covers publications in English, published by the end of 2022 and included in the Scopus. The obtained results emphasise the growing popularity of the issue, especially in the areas related to the attempt to imitate soft tissues with the use of low-cost 3D printing and plastic casting techniques.

Three-dimensional Reconstruction of Renal Vascular Tumor Anatomy to facilitate accurate preoperative planning of partial nephrectomy

Objectives

To evaluate the role of three-dimensional (3D) reconstruction tumors and vessels of the kidneys in aiding the preoperative planning of partial nephrectomy.

Materials and methods

Patients with renal tumors to be treated with partial nephrectomy were included. Each patient underwent a preoperative computed tomography (CT) survey, and the reconstruction of each patient's 3D arteriography and 3D surface-rendered tumor was performed based on the CT images for preoperative surgical planning.

Results

A total of 6 patients, three with tumors of the right kidney and three with tumors of the left kidney, were enrolled in the study. The patients' mean age was 49.33 ± 4.03 years (range: 45-57 years), and their mean tumor size was 4.4 ± 1.84 cm (range: 2.2-6.8 cm). Four underwent robot-assisted laparoscopic partial nephrectomies, one underwent a traditional laparoscopic partial nephrectomy, and one underwent a radical nephrectomy through laparotomy. Their average postoperative hospital stay was 6.7 days (range: 3-10 days). No intraoperative or postoperative complications were noted. The renal function was preserved in all the patients, and none of the patients exhibited evidence of local recurrence during more than 6 years of follow-up.

Conclusions

3D arteriography fused with 3D surface-rendered tumor image navigation facilitates precise preoperative planning.

The Role of 3D-Printed Phantoms and Devices for Organ-specified Appliances in Urology

Urology is one of the fields that are always at the frontline of bringing scientific advancements into clinical practice, including 3D printing (3DP). This study aims to discuss and presents the current role of 3D-printed phantoms and devices for organ-specified applications in urology. The discussion started with a literature search regarding the two mentioned topics within PubMed, Embase, Scopus, and EBSCOhost databases. 3D-printed urological organ phantoms are reported for providing residents new insight regarding anatomical characteristics of organs, either normal or diseased, in a tangible manner. Furthermore, 3D-printed organ phantoms also helped urologists to prepare a pre-surgical planning strategy with detailed anatomical models of the diseased organs. In some centers, 3DP technology also contributed to developing specified devices for disease management. To date, urologists have been benefitted by 3D-printed phantoms and devices in the education and disease management of organs of in the genitourinary system, including kidney, bladder, prostate, ureter, urethra, penis, and adrenal. It is safe to say that 3DP technology can bring remarkable changes to daily urological practices.

Laparoscopic nephron-sparing surgery for a tumor near the isthmus of a horseshoe kidney with a complicated blood supply

A horseshoe kidney is a congenital kidney malformation commonly associated with complications such as hydronephrosis, renal calculi, and infections of the renal pelvis. Renal cell carcinoma is extremely rare in a horseshoe kidney; once it occurs, however, it is intractable because of vascular abnormalities. This is especially true in laparoscopic nephron-sparing surgery, even for tumors of <4 cm in diameter. We herein report a case involving an asymptomatic 65-year-old man with an incidental finding of a 4-cm solid mass near the isthmus of a horseshoe kidney on B-mode ultrasonography. Preoperative computed tomography of the renal artery revealed six arterial vessels supplying the affected kidney. Laparoscopic partial nephrectomy was performed. The outcome of this case suggests that laparoscopic nephron-sparing surgery might be a successful treatment method for a horseshoe kidney but that preoperative vessel evaluation and experienced laparoscopic skills are needed.

Anatomical background of ovine kidney for use as animal model: analysis of arterial segmentation, proportional volume of each segment and arterial injury after cranial pole partial nephrectomy

OBJECTIVE

To study the arterial segments of ovine kidney, present a proportional volume analysis of each kidney arterial segment, and analyze arterial injuries caused by simulated partial nephrectomy of cranial pole.

MATERIALS AND METHODS

Forty-eight ovine kidneys injected with polyester resin into the renal arteries and collecting system were used in this study. Eighteen kidneys were used to study the arterial segments and the proportional volume of each renal segment. Other 30 kidneys were submitted to superior pole resection at a distance of 1.0cm, 0.5cm, or exactly at the cranial hilar edge, just before the resin hardening. These endocasts were used to evaluate the arterial injuries caused by these different resection planes.

RESULTS

Ovine renal artery divided into two (ventral and dorsal) or three segmental arteries. Dorsal segment presented higher proportional volume than ventral segment. For kidneys with three segments, the third segment was on the caudal region (caudo-ventral or caudo-dorsal segment) and presented the lowest proportional volume. None of the resected kidneys (at 1.0, 0.5 or at the cranial hilar edge) presented injury of arterial branches that irrigate non-resected region.

CONCLUSION

The segmental distribution of renal artery, the proportional volume of each segment and arterial injuries after cranial pole resection in ovine kidneys are different from what is observed in human kidneys. Meanwhile, ovine kidneys show a primary segmental division on anterior and posterior, as in humans, but different from swine. These anatomical characteristics should be considered when using ovine as animal models for renal experimental and/or training procedures.