The Application Of Computer-assisted Surgery System (Hisense CAS) In Pediatric Renal Surgery

Part 1 Application of computer-aided surgical system in children ’s repeated renal surgeryObjective To investigate the value and clinical significance of Hisense CAS(Hisense CAS)in pediatric repeated renal biopsy.Methods A retrospective analysis of 25 patients with Repeated kidney who were admitted to the Affiliated Hospital of Qingdao University from January 2013 to June 2017 were collected.All children underwent three-dimensional reconstruction of CAS before surgery.Accurately determine the location and size of the repeated kidney,the renal vascular system around the branches,branches and adjacent relationship,ureteral walking,stenosis,etc,the feasibility of surgery and surgical procedures,analysis of surgical time,intraoperative blood loss,blood transfusion rate.Results All children with CAS three-dimensional reconstruction can clearly show the location of the repeated kidney,size,adjacent to the relationship between the kidney and repeat the blood vessels around the branch.In 35 patients with recurrent kidney,left side(n=19),right side(n=13),both sides(n=3),complete repetitive renal(n=32),Incomplete repetitive renal(Y-type ureter)(n=3),upper type(n=35),simple repetitive kidney(n=3),Repetitive renal pelvis-ureter dilatation,hydronephrosis(n=20),repeated renal pelvis,ureteral dilatation,hydrocephalus,urinary tract infection(n=6),repeated renal pelvis,ureteral dilatation,hydrocephalus(n=5),repeated renal pelvis,ureteral dilatation,hydrocephalus,cyst 4 case of urinary tract infection;unilateral nephrectomy(n=1),discontinuous pyeloplasty(n=1),repeated renal-ureteral resection(n=32),uretero-to-bladder anastomosis(n=1).Second surgical cystectomy(n=1),The average surgical time was 122.8 minutes,and the average intraoperative blood loss was 12.91 ml.2 cases of postoperative infusion of 1U red blood cells,the average postoperative hospital stay 9d after rehabilitation discharged.Conclusions 3D visualization technology provides preoperative assessment and allows individualized surgical planning.Surgical controllability,accuracy,and safety can be improved in infants and young children undergoing precise repeated renal surgery.Part 2 Application and clinical significance of computer-assisted surgical system in precise surgery for pediatric nephroblastomaObjective To explore the value of CAS in the surgical operation of Wilms’ tumor(WT)precision surgery.Methods A retrospective analysis of 25 patients with nephroblastoma who were admitted to the Affiliated Hospital of Qingdao University from March 2013 to July 2017 were collected.All patients received upper abdominal contrast-enhanced CT scanning before surgery.12 patients used CAS system for 3D reconstruction as the reconstruction group.While 13 patients underwent 3D CT reconstruction by the CT Workstation as the control group.The clinical outcomes were analyzed and compared between the two groups.The 3D reconstruction of abdominal organs and blood vessels was generated using the CAS system.Diagnosis and preoperative planning assisted by the system was used for preoperative and intraoperative decision-making for precise surgery.Results In the reconstruction group,one children was bilateral nephroblastoma(BWT),thus underwent biopsy and chemotherapy instead of surgical resection;In the control group,3 cases have lung metastases and receive biopsy and chemotherapy.The left patients underwent successful surgery.The mean operation time was shorter in the reconstruction group(84.5 ± 21.03 min)than in the control group(149.5 ± 26.08 min)(P<0.01).The mean intraoperative blood loss was lesser in the reconstruction group(7.18 ± 5.60 ml)than in the control group(41± 34.46ml)(P<0.01).The rate of blood transfusion was lower in the reconstruction group 1% than in the control group 6%(P<0.01).The average inpatient days was shorter in the reconstruction group(7d)than in the control group(8d).The difference was statistically significant.Conclusions 3D visualization technology provides preoperative assessment and allows individualized surgical planning.Surgical controllability,accuracy,and safety can be improved in infants and young children undergoing precise nephroblastoma surgery.And it has profound guiding significance for NSS operation.