3d Virtual Reconstruction: Usefulness In Preoperative Planning For Oncologic Renal Surgery In Children

Introduction:The pre-operative planning for complex renal masses in children can be challenging, especially when nephron-sparing surgery (NSS) is recommended. We re-port our experience with the use of 3D-virtual reconstruction (3DVR) and its impact on surgical decision making. Materials and methods: Patients with complex renal masses underwent preoperative 3DVR. DICOM data were obtained from abdominal MRI and/or CT scans. 2D images segmentation was then performed. Three oncology surgeons were asked to individually evaluate each patient's preoperative MRI, CT and 3DVR. A questionnaire regarding the quality of conventional imaging compared to 3DVR was completed following surgery. Results: 8 patients (4♂,4♀) were included: Cases 1,2 and 4 were circumscribed tumours in the right upper pole, left lower pole (Bosniak cyst IV) and right mid-upper pole (Bosniak cyst IIF) respectively; Case 3 was a large hilar mass involving the whole kidney, unresponsive to chemotherapy; Case 5 and 7 were stage IV Wilms' tumour with venous thrombosis; case 6 was a left mid lower renal mass in a patient with WAGR syndrome and acute lymphoblastic leukae-mia (ALL) and case 8 was a recurrent central right WT after previous NSS in a child with Beckwith-Wiedemann syndrome(BWS). Four radical nephrectomies and three NSS were performed. In comparison to conventional imaging, the 3DVR models were judged to be superior by the expert reviewers for all anatomical structures except the urinary tract(p< 0.05). Conclusions: Our study suggests that 3DVR can be considered a useful tool in the pre-operative evaluation of children with complex renal masses and can facilitate NSS in selected patients.