New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy
, Federico Piramide 1,†, Paolo Verri 1, Enrico Checcucci 2, Sabrina De Cillis 1, Alberto Piana 1, Gabriele Volpi 2, Mariano Burgio 1, Giovanni Busacca 1, Marco Colombo 1, Cristian Fiori 1,‡ and Francesco Porpiglia 1,‡
Round 1
Reviewer 1 Report
I have read with interest the paper entitled "New generation of 3D virtual models with perfusional zones: perioperative assistance for the best pedicle management during robotic partial nephrectomy".
Overall a well written article from a urological point of view and a cutting edge and attractive topic for the audience as 3D virtual models and even more innovative as is the calculation of perfusion areas using a mathematical model.
Just a few observations and questions.
I think that the software and the mathematical model used should be better described.
In figure 3: I can read in the figure that the software mimics medical 21.0 ? was used, or am I wrong, to superimpose the intraoperative ICG view with the 3D model made. You only limit to say that a "dedicated software" was used, please mention the software, version, supplier data, in materials and methods and in the figure.
On the other hand and more importantly, for the calculation of perfusion volumes, what software was used, what was the algorithm and mathematical model? You say that "To estimate the perfusion volumes of the organ, the 3DVMs were then implemented with a software based on the Voronoi diagram, an Euclidean distance-based mathematical method used to determine vascular dominating volumes in other organs" which is based on reference 10 of the paper by Wang and cols "Precise estimation of renal vascular dominant regions using spatially aware fully convolutional networks, tensor-cut and Voronoi diagrams", they describe in detail the fully convolutional network (FCN) architecture used, as well as the algorithms for the calculation of the dominant irrigation areas and offer a model quite similar to yours. So, you should name which software you have used in your work, with version and provider, as well as if you have used the same algorithm of Wang and collaborators or how yours differs?
In figure 1, I can assume that it is a morphometric model representing several cases of tumors summed in a single image or is it a single case with 6 tumors-cysts? This should be clarified for better understanding of the readers.
Congratulations to the authors, I look forward for your response.
Author Response
I have read with interest the paper entitled "New generation of 3D virtual models with perfusional zones: perioperative assistance for the best pedicle management during robotic partial nephrectomy".
Overall a well written article from a urological point of view and a cutting edge and attractive topic for the audience as 3D virtual models and even more innovative as is the calculation of perfusion areas using a mathematical model.
We thank the reviewer for this kind comment.
Just a few observations and questions.
I think that the software and the mathematical model used should be better described.
In figure 3: I can read in the figure that the software mimics medical 21.0 ? was used, or am I wrong, to superimpose the intraoperative ICG view with the 3D model made. You only limit to say that a "dedicated software" was used, please mention the software, version, supplier data, in materials and methods and in the figure.
We thank the reviewer for this comment. To superimpose the intraoperative ICG view with the 3D model made, we used a Mimics 21.0 (Materialise, Leuven, Belgium) uploading a screen extrapolated from the intraoperative video. We add this info in the figure legend and in the MM section
On the other hand and more importantly, for the calculation of perfusion volumes, what software was used, what was the algorithm and mathematical model? You say that "To estimate the perfusion volumes of the organ, the 3DVMs were then implemented with a software based on the Voronoi diagram, an Euclidean distance-based mathematical method used to determine vascular dominating volumes in other organs" which is based on reference 10 of the paper by Wang and cols "Precise estimation of renal vascular dominant regions using spatially aware fully convolutional networks, tensor-cut and Voronoi diagrams", they describe in detail the fully convolutional network (FCN) architecture used, as well as the algorithms for the calculation of the dominant irrigation areas and offer a model quite similar to yours. So, you should name which software you have used in your work, with version and provider, as well as if you have used the same algorithm of Wang and collaborators or how yours differs?
We thank the reviewer for this comment. Medics has developed an internal proprietary algorithm based on several algorithms validated in literature, as described by Wang and collaborators. We add this info in the MM section
In figure 1, I can assume that it is a morphometric model representing several cases of tumors summed in a single image or is it a single case with 6 tumors-cysts? This should be clarified for better understanding of the readers.
We thank the reviewer for this comment. We clarify that it is just a single case with one tumor and other simple cyst.
Congratulations to the authors, I look forward for your response.
Reviewer 2 Report
I congratulate the authors for this study.
They are presenting the results of a study assessing the accuracy of 3D virtual model for guided arterial clamping strategy of the renal vessels during robotic assisted partial nephrectomy for renal tumors. The perfusion zones of the kidney were assessed using this software and the clamping strategy was performed based on these perfusion zones in order to minimize bleeding and to reduce the time and extent of the renal ischemia. The results are encouraging, meaning that the software is accurate and does make a difference in renal surgery. The article is well written, and easy to read and follow. The conclusions are based on the results and the methodology is well designed. I have no major concerns for this study.
Line 175 – the time units are missing. I presumed they are minutes
The reference style must be formatted
Author Response
I congratulate the authors for this study.
They are presenting the results of a study assessing the accuracy of 3D virtual model for guided arterial clamping strategy of the renal vessels during robotic assisted partial nephrectomy for renal tumors. The perfusion zones of the kidney were assessed using this software and the clamping strategy was performed based on these perfusion zones in order to minimize bleeding and to reduce the time and extent of the renal ischemia. The results are encouraging, meaning that the software is accurate and does make a difference in renal surgery. The article is well written, and easy to read and follow. The conclusions are based on the results and the methodology is well designed. I have no major concerns for this study.
We thank the reviewer for this kind comment.
Line 175 – the time units are missing. I presumed they are minutes
We thank the reviewer for this comment. We changed it adding the time unit (minutes)
The reference style must be formatted
We thank the reviewer for this comment. We changed the reference style according to journal guidelines
Reviewer 3 Report
This study was described that the utility of 3D virtual models for performing RARN. Overall, this manuscript iw well written. The reviewer would like to suggest some critiques as follows.
1. First of all, authors should adhere to the submission rules, especially the Reference section.
2. On line21 “k = 0.91” is correct.
3. Please reexamine the structure of the introduction. There are too many line breaks, making it difficult to understand. Similarly, please reconsider the structure of the Materials and Methods, and Discussion sections.
4. On line 128, “Clavien-Dindo” is correct.
5. Table is unclear. The authors should revise as follows;
i.e.
ASA score, median (IQR)
<2
>2
Author Response
This study was described that the utility of 3D virtual models for performing RARN. Overall, this manuscript iw well written. The reviewer would like to suggest some critiques as follows.
- First of all, authors should adhere to the submission rules, especially the Reference section.
We thank the reviewer for this comment. We change our manuscript accordingly
- On line21 “k = 0.91” is correct.
We thank the reviewer for this comment and correct this typos.
- Please reexamine the structure of the introduction. There are too many line breaks, making it difficult to understand. Similarly, please reconsider the structure of the Materials and Methods, and Discussion sections.
We thank the reviewer for this comment. We changed those sections’ structure accordingly.
- On line 128, “Clavien-Dindo” is correct.
We thank the reviewer for this comment and correct this typos.
- Table is unclear. The authors should revise as follows;
i.e.
ASA score, median (IQR)
<2
>2
We thank the reviewer for this comment and change our tables accordingly.
Round 2
Reviewer 3 Report
none.
