Surgical endoscopy · 2026
Anatomical landmark-based proportional coordinate localization in laparoscopic partial nephrectomy for completely endophytic renal tumors.
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Sui Yapeng, Zhang Xiang, Wei Ziwei, Li Guanghao, Yan Lei, Zhang Cong
Аннотация
BACKGROUND: Accurate localization of completely endophytic renal tumors remains challenging in laparoscopic partial nephrectomy, and conventional intraoperative ultrasonography is experience-dependent.
OBJECTIVE: To evaluate an intraoperative localization technique based on AI-assisted three-dimensional reconstruction and an anatomical landmark-based proportional coordinate system (XYZ).
METHODS: We retrospectively analyzed 105 patients treated from May 2016 to July 2025. Patients were assigned to the XYZ coordinate-guided localization group (n = 52), using preoperative three-dimensional planning, calculation of the proportional XYZ coordinates, and intraoperative ultrasonographic verification, or the traditional localization group (n = 53), using conventional imaging and intraoperative ultrasonographic scanning. Localization efficiency, perioperative outcomes, and trifecta achievement were compared.
RESULTS: Baseline characteristics were comparable. Compared with the traditional localization group, the XYZ coordinate-guided localization group had shorter localization time (225.5 s vs 317.0 s, p < 0.001), higher first-attempt localization success rate (59.62% vs 37.74%, p = 0.025), shorter warm ischemia time (21.73 min vs 27.19 min, p < 0.001), and higher trifecta achievement rate (61.54% vs 24.52%, p < 0.001). Estimated blood loss was lower (105.0 mL vs 130.0 mL, p = 0.035), blood transfusion tended to be reduced (3.85% vs 16.98%, p = 0.052), and acute kidney injury was less frequent (11.54% vs 28.30%, p = 0.032). Multivariable regression confirmed XYZ coordinate-guided localization group was associated with higher odds of achieving the trifecta and shorter warm ischemia time.
CONCLUSION: In the present study, XYZ coordinate-guided localization was associated with shorter intraoperative localization and warm ischemia times and a higher rate of achieving the trifecta than traditional localization. We will conduct prospective multicenter studies to further evaluate its effectiveness and generalizability.
OBJECTIVE: To evaluate an intraoperative localization technique based on AI-assisted three-dimensional reconstruction and an anatomical landmark-based proportional coordinate system (XYZ).
METHODS: We retrospectively analyzed 105 patients treated from May 2016 to July 2025. Patients were assigned to the XYZ coordinate-guided localization group (n = 52), using preoperative three-dimensional planning, calculation of the proportional XYZ coordinates, and intraoperative ultrasonographic verification, or the traditional localization group (n = 53), using conventional imaging and intraoperative ultrasonographic scanning. Localization efficiency, perioperative outcomes, and trifecta achievement were compared.
RESULTS: Baseline characteristics were comparable. Compared with the traditional localization group, the XYZ coordinate-guided localization group had shorter localization time (225.5 s vs 317.0 s, p < 0.001), higher first-attempt localization success rate (59.62% vs 37.74%, p = 0.025), shorter warm ischemia time (21.73 min vs 27.19 min, p < 0.001), and higher trifecta achievement rate (61.54% vs 24.52%, p < 0.001). Estimated blood loss was lower (105.0 mL vs 130.0 mL, p = 0.035), blood transfusion tended to be reduced (3.85% vs 16.98%, p = 0.052), and acute kidney injury was less frequent (11.54% vs 28.30%, p = 0.032). Multivariable regression confirmed XYZ coordinate-guided localization group was associated with higher odds of achieving the trifecta and shorter warm ischemia time.
CONCLUSION: In the present study, XYZ coordinate-guided localization was associated with shorter intraoperative localization and warm ischemia times and a higher rate of achieving the trifecta than traditional localization. We will conduct prospective multicenter studies to further evaluate its effectiveness and generalizability.