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De Backer P, Vermijs S, Van Praet C, De Visschere P, Vandenbulcke S, Mottaran A, Bravi CA, Berquin C, Lambert E, Dautricourt S, Goedertier W, Mottrie A, Debbaut C, Decaestecker K. A Novel Three-dimensional Planning Tool for Selective Clamping During Partial Nephrectomy: Validation of a Perfusion Zone Algorithm. Eur Urol 2023; 83:413-421. [PMID: 36737298 DOI: 10.1016/j.eururo.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/25/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Selective clamping during robot-assisted partial nephrectomy (RAPN) requires extensive knowledge on patient-specific renal vasculature, obtained through imaging. OBJECTIVE To validate an in-house developed perfusion zone algorithm that provides patient-specific three-dimensional (3D) renal perfusion information. DESIGN, SETTING, AND PARTICIPANTS Between October 2020 and June 2022, 25 patients undergoing RAPN at Ghent University Hospital were included. Three-dimensional models, based on preoperative computed tomography (CT) scans, showed the clamped artery's ischemic zone, as calculated by the algorithm. SURGICAL PROCEDURE All patients underwent selective clamping during RAPN. Indocyanine green (ICG) was administered to visualize the true ischemic zone perioperatively. Surgery was recorded for a postoperative analysis. MEASUREMENTS The true ischemic zone of the clamped artery was compared with the ischemic zone predicted by the algorithm through two metrics: (1) total ischemic zone overlap and (2) tumor ischemic zone overlap. Six urologists assessed metric 1; metric 2 was assessed objectively by the authors. RESULTS AND LIMITATIONS In 92% of the cases, the algorithm was sufficiently accurate to plan a selective clamping strategy. Metric 1 showed an average score of 4.28 out of 5. Metric 2 showed an average score of 4.14 out of 5. A first limitation is that ICG can be evaluated only at the kidney surface. A second limitation is that mainly patients with impaired renal function are expected to benefit from this technology, but contrast-enhanced CT is required at present. CONCLUSIONS The proposed new tool demonstrated high accuracy when planning selective clamping for RAPN. A follow-up prospective study is needed to determine the tool's clinical added value. PATIENT SUMMARY In partial nephrectomy, the surgeon has no information on which specific arterial branches perfuse the kidney tumor. We developed a surgeon support system that visualizes the perfusion zones of all arteries on a three-dimensional model and indicates the correct arteries to clamp. In this study, we validate this tool.
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Affiliation(s)
- Pieter De Backer
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium; IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent Belgium; ORSI Academy, Melle, Belgium.
| | - Saar Vermijs
- IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Charles Van Praet
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent Belgium
| | - Pieter De Visschere
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sarah Vandenbulcke
- IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Angelo Mottaran
- ORSI Academy, Melle, Belgium; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Carlo A Bravi
- ORSI Academy, Melle, Belgium; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Camille Berquin
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - Edward Lambert
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - Stéphanie Dautricourt
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - Wouter Goedertier
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Charlotte Debbaut
- IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Karel Decaestecker
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent Belgium; Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium
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Vandenbulcke S, De Pauw T, Dewaele F, Degroote J, Segers P. Computational fluid dynamics model to predict the dynamical behavior of the cerebrospinal fluid through implementation of physiological boundary conditions. Front Bioeng Biotechnol 2022; 10:1040517. [PMID: 36483773 PMCID: PMC9722737 DOI: 10.3389/fbioe.2022.1040517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 10/22/2023] Open
Abstract
Cerebrospinal fluid (CSF) dynamics play an important role in maintaining a stable central nervous system environment and are influenced by different physiological processes. Multiple studies have investigated these processes but the impact of each of them on CSF flow is not well understood. A deeper insight into the CSF dynamics and the processes impacting them is crucial to better understand neurological disorders such as hydrocephalus, Chiari malformation, and intracranial hypertension. This study presents a 3D computational fluid dynamics (CFD) model which incorporates physiological processes as boundary conditions. CSF production and pulsatile arterial and venous volume changes are implemented as inlet boundary conditions. At the outlets, 2-element windkessel models are imposed to simulate CSF compliance and absorption. The total compliance is first tuned using a 0D model to obtain physiological pressure pulsations. Then, simulation results are compared with in vivo flow measurements in the spinal subarachnoid space (SAS) and cerebral aqueduct, and intracranial pressure values reported in the literature. Finally, the impact of the distribution of and total compliance on CSF pressures and velocities is evaluated. Without respiration effects, compliance of 0.17 ml/mmHg yielded pressure pulsations with an amplitude of 5 mmHg and an average value within the physiological range of 7-15 mmHg. Also, model flow rates were found to be in good agreement with reported values. However, when adding respiration effects, similar pressure amplitudes required an increase of compliance value to 0.51 ml/mmHg, which is within the range of 0.4-1.2 ml/mmHg measured in vivo. Moreover, altering the distribution of compliance over the four different outlets impacted the local flow, including the flow through the foramen magnum. The contribution of compliance to each outlet was directly proportional to the outflow at that outlet. Meanwhile, the value of total compliance impacted intracranial pressure. In conclusion, a computational model of the CSF has been developed that can simulate CSF pressures and velocities by incorporating boundary conditions based on physiological processes. By tuning these boundary conditions, we were able to obtain CSF pressures and flows within the physiological range.
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Affiliation(s)
- Sarah Vandenbulcke
- Institute of Biomedical Engineering and Technology (IBiTech-bioMMeda), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Tim De Pauw
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Dewaele
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Joris Degroote
- Department of Electromechanical Systems and Metal Engineering, Ghent University, Ghent, Belgium
| | - Patrick Segers
- Institute of Biomedical Engineering and Technology (IBiTech-bioMMeda), Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
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