Choice of surgical access for retroperitoneoscopic ureterolithotomy according to the results of 3D reconstruction of operational zone agreed with the patient: initial experience

摘要

Introduction. For the procedure retroperitoneoscopic ureterolithotomy, the problems of access choiceand thus visualization with utilizing minimally invasive surgical access (either with gasless single portmethod or gas insufflation) are solved. The decisions are based on the method of presurgery planning,grounded on matching the patient with a 3D model of the zone of surgical interest reconstructed accordingto the results of tomographic examination.Material and methods. We used a hardware–software complex (HSC) for virtual modeling of thesurgery zone and choosing the optimum points for minimally invasive surgical access. The HSC was recruitedto choose optimum surgical access, realize presurgery planning, and estimation of the safety ofthe way of access chosen. The original method of matching the system of coordinates of a virtual modelwith the patient was offered.Results. 12 patients with the calculus in the upper part of ureter averaging 11.5 (9–14) mm in size underwentgasless retroperitoneoscopic ureterolithotomy with use of the HSC. Mean age of the patientswas 36.4 (25–49) years old. The surgeries lasted an average of 35.5 (25–40) minutes. Blood loss wasaveraged at 55.0 (30–90) ml. Healing by first intention was registered with all the patients. The meanhospitalization time was 6.0 (4–7) days. There were neither any complications nor difficulties, nor conversionsfrom incorrectly chosen surgical access.Conclusions. The choice of the optimum surgical access according to the results of a virtual 3D modelof the operation zone, matching the system of coordinates of the model with patient concurrence, andpresurgery planning, was effective in cases of gasless single port and with gas insufflation retroperitoneoscopicureterolithotomy.