【Foreword】Precision surgery leverages CT/MRI imaging data to create preoperative 3D models and develop surgical plans, mitigating risks. During procedures, 3D laparoscopic techniques and robotic assistance ensure efficiency and safety.For years, Professor Wang Dongwen's team at the First Hospital of Shanxi Medical University has dedicated itself to exploring and applying 3D technology in renal tumor diagnosis and treatment. This work has achieved seamless integration between "digital medicine" and "precision surgery," benefiting more patients.
【Expert Insights】The Precision Era in Renal Cancer Surgery
Over the past decade, the concepts of "precision surgery" and "digital medicine" have advanced hand-in-hand, mutually reinforcing each other and driving the clinical diagnosis and treatment of renal tumors toward greater precision.
The era of precision in renal cancer diagnosis and treatment has arrived. Particularly in surgery, "precision" care for kidney tumor patients has expanded beyond the operating table to encompass preoperative diagnosis, surgical planning, patient consultations, and intraoperative localization.In other words, the relatively "rough" perioperative management of renal cell carcinoma is becoming a thing of the past. Today, a "comprehensive perioperative precision" approach—encompassing precise preoperative localization and diagnosis, meticulous surgical planning, detailed 3D visualization and physical counseling, intraoperative precise localization and guidance, and challenge early warning—is being progressively proposed, widely recognized, and extensively implemented within the field.In just over a decade, digital technology has propelled precision surgery for renal tumors from a relatively "rough-and-ready" approach toward comprehensive perioperative precision.
This advancement has expanded both physicians' and patients' understanding of precision surgery beyond "minimal invasion, maximum preservation" to encompass "minimal cost, optimal outcomes." It has also heightened demands for designing and implementing "personalized treatment" plans.
【Expert Insights】The "Soft Power" of Precision Diagnosis and Treatment in Renal Cancer Surgery—3D Reconstruction and Complication Prediction
>With technological advancements, our team pioneered efforts as early as 2011 to break away from traditional surgical approaches. (Clinicians typically relied on patients' CT, MRI, and other imaging data, subjectively piecing together and visualizing the three-dimensional anatomical structures of the surgical site based on two-dimensional information from images before and during surgery to guide their procedures.) Utilizing three-dimensional reconstruction technology, we transformed two-dimensional images like CT scans into three-dimensional graphical representations.This new objective, quantitative, and intuitive method of acquiring imaging information enables physicians to better grasp the anatomical features of the region, driving a significant shift in traditional diagnostic and therapeutic models from the "film-reading era" to the "image-reviewing era."
Subsequently, we systematically launched applications and research related to precision surgery for renal cell carcinoma, persisting with unwavering dedication over the years.Preoperatively, 3D reconstruction technology generates personalized digital models of the retroperitoneal space. By freely examining three-dimensional variations in renal arteries and veins, as well as the vascular and tissue conditions at the tumor base, we formulate precise surgical plans. Intraoperatively, real-time comparisons between the 3D model and actual surgical views facilitate the smooth and accurate completion of renal tumor resection.
Now, they have pioneered the SIREN scoring system—the first quantitative assessment system specifically designed for renal vascular anatomy in China and internationally. This system quantifies the impact of renal vascular anatomy on surgical difficulty, facilitating physician understanding and communication. Simultaneously, its comprehensive, intuitive, and three-dimensional visualization of critical renal anatomical structures enables more precise, safe, and effective vascular difficulty prediction, preoperative planning optimization, and surgical execution.
Consequently, surgeons not only obtain a "3D map" of the surgical field for meticulous preoperative planning but also gain real-time reference during surgery for structural identification. Additionally, they receive a quantitative assessment report on renal vascular complexity, further enhancing preoperative planning and difficulty prediction.To date, over a thousand renal cancer patients have benefited from this precision surgery, meeting the evolving demands for high-quality medical care characterized by precision, minimally invasive techniques, safety, and rapid recovery.
【Expert Insights】The "Hard Power" of Precision Diagnosis and Treatment in Renal Cancer Surgery—3D Laparoscopy and Robotics
Surgical approaches for renal cell carcinoma have long moved beyond traditional open surgery. Over the years, laparoscopic renal procedures have gained widespread adoption in China due to their advantages of minimal trauma, rapid recovery, and fewer complications. Their application now encompasses nearly all urological laparoscopic surgeries involving the adrenal glands, kidneys, ureters, prostate, and bladder.Technological advancements—from 2D to 3D laparoscopic visualization and from straight-arm instruments to robotic arms with seven degrees of freedom and wrist-like articulation—have significantly enhanced surgical precision and safety. Patients directly benefit from faster, more complete recovery.
Specifically, since 3D laparoscopic technology builds upon the 2D laparoscopic operating model with enhanced 3D visualization, patients generally suitable for 2D laparoscopic treatment are also suitable for 3D laparoscopy.For renal tumor surgeries—such as resections involving tumors closely related to surrounding structures or vessels, partial nephrectomies, or caval vein tumor thrombus extractions—3D laparoscopy offers particular advantages.
With relatively low investment costs and excellent high-definition stereoscopic imaging, 3D laparoscopy creates a near-realistic three-dimensional surgical field for surgeons, restoring authentic visual perception. This enhances surgical efficiency and safety to a certain extent while allowing continued use of existing traditional laparoscopic instruments, techniques, and procedures, thereby lowering the technical threshold. It is often regarded as a transitional step between 2D laparoscopy and robotic-assisted laparoscopy,It will remain the primary surgical technique for the foreseeable future.
Robotic-assisted laparoscopic systems, developed in recent years, offer even clearer 3D visualization with naked-eye stereoscopic effects. More importantly, they enable precise 7-degree-of-freedom manipulation, demonstrating significant advantages in complex renal tumor surgeries—particularly during suturing procedures in partial nephrectomy. Consequently, they are now recognized as the future direction of surgical advancement.
【Expert Insights】Humanizing Precision Diagnosis and Treatment in Renal Cancer Surgery—3D Visualization or Physical Models in Doctor-Patient Discussions
While enhancing surgical techniques, it is equally crucial to focus on how to intuitively convey anatomical information about the kidney and tumor to patients preoperatively. Explaining the key points and challenges of the surgery enables patients and their families to understand the treatment plan, build mutual trust with the surgeon, and actively cooperate—all vital measures for improving surgical success rates.
Currently, preoperative communication for renal tumors primarily relies on explanations using CT and MRI films. For most patients and families without medical backgrounds, comprehending the information in cross-sectional images and the surgical plan derived from them is extremely challenging. Today, 3D reconstruction can nearly realistically restore the three-dimensional structure of the patient's surgical area, allowing patients and families to understand the surgery more intuitively.Simultaneously, as 3D printing technology demonstrates promising rapid development in the medical field, we have integrated personalized 3D-printed physical models with animated digital 3D simulations into preoperative communication. This approach aims to deepen patients' and families' understanding of the procedure and provide a more realistic perception of the surgical site's anatomy.The results have proven highly effective. The combination of physical 3D models and digital animations significantly reduces the spatial integration and abstract thinking required of patients, enhancing their preoperative understanding of the procedure. This approach not only mitigates or eliminates psychological fears associated with the unknown but also strengthens patient and family trust in the surgical team—a crucial factor in the success of surgical treatment.【Expert Insights】Virtual & Mixed Reality Technologies: The "Sky-High" Frontier in Precision Renal Cancer Surgery