BACKGROUND:Postoperative pain relief after laparoscopic appendicectomy in children provided by transversus abdominis plane (TAP) block and local anaesthesia wound infiltration (LAWI) of trocar insertion sites has never been compared. OBJECTIVE:To investigate whether TAP block could decrease postoperative opioid requirements after laparoscopic appendicectomy in children compared with LAWI. DESIGN:Multicentre, double-blind, phase III randomised trial. SETTING:Two tertiary paediatric surgery centres. PATIENTS:Children aged 3 to 15 years admitted for laparoscopic appendicectomy. MAIN OUTCOME MEASURES:The primary outcome was the total dose of nalbuphine delivered within 24 h after surgery. Secondary outcomes were the Face Legs Activity Cry Consolability (FLACC) scale values at 1, 2, 6, 12 and 24 h, the time from levobupivacaine injection to the first dose of nalbuphine, and the time from the end of surgery to the first mobilisation. Patients received either ultrasound-guided TAP block (TAP group) or LAWI of trocar insertion sites (infiltration group) with 0.6 ml kg -1 of levobupivacaine 2.5 mg ml -1 , combined with standardised systemic multimodal analgesia including paracetamol, ketoprofen, phloroglucinol and nalbuphine. RESULTS:Forty-six and 50 patients were analysed in the TAP and infiltration groups, respectively [age: 10 [7 to 12] versus 10 [8 to 12] years; females: 16 (35%) versus 25 (50%); duration of surgery: 71 [64 to 90] versus 69 [56 to 89] min]. The primary outcome (total nalbuphine dose) was 0.2 [0.0 to 0.2] and 0.2 [0.0 to 0.2] mg kg -1 in the TAP and infiltration groups, respectively ( P  = 0.95). FLACC scale values did not significantly differ between the two groups ( P  = 0.78). Time to the first dose of nalbuphine or to first mobilisation was not significantly different between groups ( P value for log-rank test = 0.095 and 0.18, respectively). CONCLUSION:TAP block does not appear to provide a greater opioid-sparing effect than LAWI of trocar insertion sites after laparoscopic appendicectomy in children, when combined with systemic multimodal analgesia including nonsteroidal anti-inflammatory drugs. TRIAL REGISTRATION:ClinicalTrials.gov NCT04969133.

BACKGROUND Postoperative pain relief after laparoscopic appendicectomy in children provided by transversus abdominis plane (TAP) block and local anaesthesia wound infiltration (LAWI) of trocar insertion sites has never been compared. OBJECTIVE To investigate whether TAP block could decrease postoperative opioid requirements after laparoscopic appendicectomy in children compared with LAWI. DESIGN Multicentre, double-blind, phase III randomised trial. SETTING Two tertiary paediatric surgery centres. PATIENTS Children aged 3 to 15 years admitted for laparoscopic appendicectomy. MAIN OUTCOME MEASURES The primary outcome was the total dose of nalbuphine delivered within 24 h after surgery. Secondary outcomes were the Face Legs Activity Cry Consolability (FLACC) scale values at 1, 2, 6, 12 and 24 h, the time from levobupivacaine injection to the first dose of nalbuphine, and the time from the end of surgery to the first mobilisation. Patients received either ultrasound-guided TAP block (TAP group) or LAWI of trocar insertion sites (infiltration group) with 0.6 ml kg −1 of levobupivacaine 2.5 mg ml −1 , combined with standardised systemic multimodal analgesia including paracetamol, ketoprofen, phloroglucinol and nalbuphine. RESULTS Forty-six and 50 patients were analysed in the TAP and infiltration groups, respectively [age: 10 [7 to 12] versus 10 [8 to 12] years; females: 16 (35%) versus 25 (50%); duration of surgery: 71 [64 to 90] versus 69 [56 to 89] min]. The primary outcome (total nalbuphine dose) was 0.2 [0.0 to 0.2] and 0.2 [0.0 to 0.2] mg kg −1 in the TAP and infiltration groups, respectively ( P = 0.95). FLACC scale values did not significantly differ between the two groups ( P = 0.78). Time to the first dose of nalbuphine or to first mobilisation was not significantly different between groups ( P value for log-rank test = 0.095 and 0.18, respectively). CONCLUSION TAP block does not appear to provide a greater opioid-sparing effect than LAWI of trocar insertion sites after laparoscopic appendicectomy in children, when combined with systemic multimodal analgesia including nonsteroidal anti-inflammatory drugs. TRIAL REGISTRATION ClinicalTrials.gov NCT04969133.

Objective: This study provides a comprehensive global overview of surgical instrument traceability systems and accentuates their growing importance in healthcare. Background: Surgical instruments pose risks to patient safety, economic costs, logistical challenges, and environmental impact. The increasing focus on instrument traceability reflects its potential to address these issues. Methods: We performed a systematic review using PRISMA guidelines, analyzing articles from 2000 to 2023 across five digital libraries (PubMed, Web of Science, IEEE, ACM, Google Scholar). Our review concentrated on traceability systems’ lifecycle for reusable and sterile surgical instruments. Results: Out of 7189 articles retrieved, 22 were selected for evaluation, and only 6 were considered relevant after a thorough examination. These studies mainly deployed Radio Frequency Identification (RFID) technology. They enhance patient safety, reduce environmental impact, improve economic efficiency, and optimize logistics. Additionally, these systems encourage more responsible surgical practices. Conclusions: Our study underscores the limited applied research in this field and discusses system architectures and performance metrics. It proposes future research directions, including the development of public databases, integration of automation, and investment in artificial intelligence (AI) and computer vision to improve traceability and risk analysis.

Objectives: To evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests. Methods: Retrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history and outcomes of patients with or without undernutrition (body mass index (BMI) z-score < -2 SD) at the age of 6-9 years were compared. Results: Of the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 +/- 0.4. At birth, 13 (65%) of them where preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p=0.002), and 60% of them required pulmonary treatments (vs 32%, p=0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio OR=6.0), hernia/cryptorchidism surgery (OR=5.2), a restrictive syndrome (OR=3.3) and pulmonary crisis treatment use (OR=2.7) as risk factors for undernutrition. Conclusions: In contrast to intestinal and esophageal surgeries, the respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study was funded by the University Hospital Centre of Angers (grant number 49RC19\_0185\_2), the non-profit sector associations "Institut de Recherche en Sante Respiratoire des Pays de la Loire (IRSR-PdL)" and the "Filiere des Maladies rares Abdomino-THOraciques (FIMATHO)". ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of the University Hospital Center of Angers gave ethical approvel for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

OBJECTIVES:To evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests at school-age. METHODS:Retrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history, and outcomes of patients with or without undernutrition (body mass index [BMI] z-score < -2 SD) at the age of 6-9 years were compared. RESULTS:Of the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 ± 0.4. At birth, 13 (65%) of them were preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs. 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p = 0.002), and 60% of them required pulmonary treatments (vs. 32%, p = 0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio [OR] = 6.0), hernia/cryptorchidism surgery (OR = 5.2), a restrictive syndrome (OR = 3.3) and pulmonary crisis treatment use (OR = 2.7) as associated with undernutrition. CONCLUSIONS:In contrast to intestinal and esophageal surgeries, respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA. CLINICAL TRIAL REGISTRATION:NCT04136795. (https://clinicaltrials.gov/study/NCT04136795?term=RestriMIS&rank=1).

OBJECTIVES:To identify the factors that result in a restrictive ventilatory impairment during childhood following type III esophageal atresia (EA) repair. STUDY DESIGN:A multicentre, retrospective, national cohort study was conducted on 503 patients who had undergone surgery for EA between 2008 and 2013. The results of pulmonary function tests (PFT) performed during childhood were used to compare patients with pure restrictive lung impairment to children with normal PFT. Subsequently, logistic regression was employed to ascertain potential risk factors for restrictive syndrome in type III EA. RESULTS:The cohort comprised 503 patients, of whom 216 (42.9 %) had interpretable PFT. Among them, 63.4 % exhibited normal results, 26.9 % pure restriction, 5.1 % pure obstruction, and 4.6 % a mixed pattern. Patient-associated factors that were associated with a restrictive impairment were birth weight, Caucasian ethnicity (odds ratio (OR) 4.3 [1.2-15.4]), and the presence of neonatal heart defects (OR = 5.8). [1.9-16.9]), tracheomalacia (OR = 4.1 [1.6-10.2]) and neonatal GERD (OR = 3.1 [1.3-7.4]). The sole healthcare-associated factor was the use of respiratory crisis treatment during childhood (OR = 4.8 [1.3-18.0]), whereas neither surgical factor nor postoperative parietal thoracic deformity was associated with restriction. CONCLUSION:In contrast to surgical approaches or chest wall abnormalities, neonatal EA-associated conditions appear to be associated with a restrictive pattern during childhood, but further prospective studies remain mandatory to validate these results.

BACKGROUND:3D reconstruction of Wilms' tumor provides several advantages but are not systematically performed because manual segmentation is extremely time-consuming. The objective of our study was to develop an artificial intelligence tool to automate the segmentation of tumors and kidneys in children. METHODS:A manual segmentation was carried out by two experts on 14 CT scans. Then, the segmentation of Wilms' tumor and neoplastic kidney was automatically performed using the CNN U-Net and the same CNN U-Net trained according to the OV2ASSION method. The time saving for the expert was estimated depending on the number of sections automatically segmented. RESULTS:When segmentations were performed manually by two experts, the inter-individual variability resulted in a Dice index of 0.95 for tumor and 0.87 for kidney. Fully automatic segmentation with the CNN U-Net yielded a poor Dice index of 0.69 for Wilms' tumor and 0.27 for kidney. With the OV2ASSION method, the Dice index varied depending on the number of manually segmented sections. For the segmentation of the Wilms' tumor and neoplastic kidney, it varied respectively from 0.97 to 0.94 for a gap of 1 (2 out of 3 sections performed manually) to 0.94 and 0.86 for a gap of 10 (1 section out of 6 performed manually). CONCLUSION:Fully automated segmentation remains a challenge in the field of medical image processing. Although it is possible to use already developed neural networks, such as U-Net, we found that the results obtained were not satisfactory for segmentation of neoplastic kidneys or Wilms' tumors in children. We developed an innovative CNN U-Net training method that makes it possible to segment the kidney and its tumor with the same precision as an expert while reducing their intervention time by 80%.

Polytetrafluoroethylene (PTFE) and, by extension, fluoropolymers are ubiquitous in science, life, and the environment as perfluoroalkyl pollutants (PFAS). In all cases, it is difficult to transform these materials due to their chemical inertness. Herein, we report a direct amination process of PTFE and some fluoropolymers such as polyvinylidene fluoride (PVDF) and Nafion by lithium alkylamide salts. Synthesizing these reactants extemporaneously between lithium metal and an aliphatic primary di- or triamine that also serves as a solvent leads to the rapid nucleophilic substitution of fluoride by an alkylamide moiety when in contact with the fluoropolymer. Moreover, lithium alkylamides dissolved in suitable solvents other than amines can react with fluoropolymers. This highly efficient one-pot process opens the way for further surface or bulk modification if needed, providing an easy, inexpensive, and fast experiment protocol on large scales.

Purpose Hypospadias surgery is challenging. Numerous techniques have been described with variable complication rates. The main objectives of our study were to evaluate the urethroplasty complication rate of primary hypospadias repair and to identify risk factors for complications. Methods We retrospectively evaluated the outcomes of all patients who underwent primary hypospadias repair in our department between January 2012 and December 2020. Demographic, anatomical, operative, and postoperative data were reported. Univariate and multivariate logistic regression analyses were performed to identify variables associated with complications. Statistical significance was set at p < 0.05. Results Of 292 patients, 203 (69.5%) had distal hypospadias, 63 (21.6%) had mid-penile hypospadias, and 26 (8.9%) had proximal hypospadias. The mean age at the time of surgery was 22.8 months. Seventy-eight patients (26.7%) had urethroplasty complications. The rate of complications was higher for proximal hypospadias (57.7%), onlay island flap (44.4%), and Koyanagi (75%) procedures. The mean follow-up duration was 29 months. Two predictors of complications were identified by multivariate analysis: catheterization duration and urethroplasty technique. The reoperation rate was 30.5%. Conclusion Urethroplasty complications frequently occur after primary hypospadias repair. The complication rate was higher in proximal hypospadias. Catheterization duration and surgical technique were significant predictors of complications. A longer and more standardized follow-up is needed for a better assessment of hypospadias repair outcomes.

Purpose:Postoperative pain relief after laparoscopic appendicectomy is a key determinant of early rehabilitation in children. Recent guidelines recommend performing either a transversus abdominis plane (TAP) block or local anesthesia (LA) wound infiltration as part of multimodal postoperative analgesia after appendectomy. To date, the clinical effectiveness of TAP block versus LA wound infiltration has never been compared. The hypothesis of this study is that the TAP block may provide a greater opioid-sparing effect after laparoscopic appendicectomy in children than LA wound infiltration.Study Design and Methods:We designed a multicenter double-blind randomized controlled phase III trial and aim to include 110 children who undergo laparoscopic appendicectomy. Children are randomized to receive either TAP block (TAP group) or LA wound infiltration (infiltration group). Multimodal analgesia is standardized in the two groups using the same protocol, which includes the stepwise prescription of paracetamol, phloroglucinol, ketoprofene, and nalbuphine according to the hetero-evaluation of pain performed by the nurses who were blinded to the treatment allocated using the validated FLACC scale. The primary outcome is the total dose of nalbuphine administered within 24 hours after surgery.Discussion:No study has specifically compared the clinical effectiveness of TAP block versus LA wound infiltration for postoperative pain relief after laparoscopic appendectomy in children. This paper describes the protocol for a randomized trial that addresses this issue. The results of this trial will be useful for editing guidelines with a higher level of evidence on this topic.

Polytetrafluoroethylene (PTFE) is a ubiquitous material used for implants and medical devices in general because of its high biocompatibility and inertness: blood vessel, heart, table jawbone, nose, eyes, or abdominal wall can benefit from its properties in case of disease or injury. Its expanded version, ePTFE is an improved version of PTFE with better mechanical properties, which extends its medical applications. A material as frequently used as ePTFE with these exceptional properties deserves a review of its main uses, developments, and possibility of improvements. In this systematic review, we examined clinical trials related to ePTFE-based medical devices from the literature. Then, we excluded all trials using ePTFE as a control to test other devices. ePTFE-coated stents, hemodialysis and bypass grafts, guided bone and tissue regeneration membranes, hernia and heart repair and other devices are reviewed. The rates of success using these devices and their efficiency compared to other materials used for the same purposes are reported. ePTFE appears to be more or just as efficient compared to them. Some success rates remain low, suggesting the need of improvement ePTFE for medical applications.

Wet etching of polytetrafluoroethylene by sodium naphthalenide dissolved in diglyme solution was investigated experimentally and theoretically. First, the irreversible modification of the polymer surface was analyzed by Raman and XPS spectroscopies, water wetting angle measurements and AFM observations. The drastic changes brought to the surface of PTFE could be clearly demonstrated by these analytical methods. Then, first principle calculations coupled to molecular dynamics (FPMD) were performed to simulate the first steps of the reaction involved in the process of surface modification. It has been shown that fluorine directly attacks vicinal sodium with formation of a pair of sodium fluoride ions without grafting of the naphthalene moiety onto the modified surface. While the formation of the alkene and alkyne bond can be modelized, no spectroscopic signature is observed after rinsing etched PTFE.

Convolutional neural networks (CNNs) have proven to be efficient tools for image segmentation when a large number of segmented images are available. However, when the number of segmented images is not so large, the CNN segmentations are less accurate. It is the case for nephroblastoma (kidney cancer) in particular. When a new patient arrives, the expert can only manually segment a sample of scanned images since manual segmentation is a time-consuming process. As a consequence, the question of how to compute accurate segmentations using both the trained CNN and such a sample is raised. A CBR approach based on proportional analogy is proposed in this paper. For a source image segmented by the expert, let a be the CNN segmentation of this image, b be its expert segmentation and c be the CNN segmentation of a target image close to the source image. The proposed approach aims at solving the analogical equation “a is to b as c is to d” with unknown d: the solution d of this equation is proposed as a segmentation of the target image. This approach and some of its improvements are evaluated and show an accuracy increase of the segmentation with respect to the CNN segmentation.

Managing the risks arising from the actions and conditions of the various elements that make up an operating room is a major concern during a surgical procedure. One of the main challenges is to define alert thresholds in a non-deterministic context where unpredictable adverse events occur. In response to this problematic, this paper presents an architecture that couples a Multi-Agent System (MAS) with Case-Based Reasoning (CBR). The possibility of emulating a large number of situations thanks to MAS, combined with analytical data management thanks to CBR, is an original and efficient way of determining thresholds that are not defined a priori. We also compared different similarity calculation methods (Retrieve phase of CBR). The results presented in this article show that our model can manage alert thresholds in an environment that manages data as disparate as infectious agents, patient's vitals and human fatigue. In addition, they reveal that the thresholds proposed by the system are more efficient than the predefined ones. These results tend to prove that our simulator is an effective alert generator. Nevertheless, the context remains a simulation mode that we would like to enrich with real data from, for example, monitoring sensors (bracelet for human fatigue, monitoring, etc).

Managing risks related to the actions and conditions of the various elements that make up an operating room is a major concern during surgery. Determining alert thresholds is one of the main challenges. In this document, we propose to focus on the causes that lead to incidents as well as their prediction, which are essential elements in the determination of alerts. For that purpose, we have designed an architecture that couples a Multi-Agent System (MAS) with Case-Based Reasoning (CBR). The ability to emulate a large number of situations thanks to MAS, combined with analytical data management thanks to CBR is an efficient way of analyzing the state of the system and predicting its evolution. Beyond this architecture, decision support tools have been integrated in order to classify the behavior of entities and predict their evolution. This paper presents and analyzes the performance of our original cluster-based method (similVar) dedicated to the determination of unpredefined alert thresholds and risk prediction in surgery rooms. The obtained results prove the ability of our approach to analyze and predict the evolution of variables as disparate as the constants of a patient ("CAPNIA", "HYPOTHERMIA", "FeCO2", "SpO2" etc.) or human fatigue.

An important component of tissue engineering (TE) is the supporting matrix upon which cells and tissues grow, also known as the scaffold. Scaffolds must easily integrate with host tissue and provide an excellent environment for cell growth and differentiation. Human amniotic membrane (hAM) is considered as a surgical waste without ethical issue, so it is a highly abundant, cost-effective, and readily available biomaterial. It has biocompatibility, low immunogenicity, adequate mechanical properties (permeability, stability, elasticity, flexibility, resorbability), and good cell adhesion. It exerts anti-inflammatory, antifibrotic, and antimutagenic properties and pain-relieving effects. It is also a source of growth factors, cytokines, and hAM cells with stem cell properties. This important source for scaffolding material has been widely studied and used in various areas of tissue repair: corneal repair, chronic wound treatment, genital reconstruction, tendon repair, microvascular reconstruction, nerve repair, and intraoral reconstruction. Depending on the targeted application, hAM has been used as a simple scaffold or seeded with various types of cells that are able to grow and differentiate. Thus, this natural biomaterial offers a wide range of applications in TE applications. Here, we review hAM properties as a biocompatible and degradable scaffold. Its use strategies (i.e., alone or combined with cells, cell seeding) and its degradation rate are also presented.

Les consultations de transition permettent d’effectuer un relais du dossier médical du patient entre chirurgiens pédiatres, médecins rééducateurs et urologues adultes. Elles permettent d’éviter à ces patients d’être perdus de vue alors que pronostic fonctionnel du haut appareil urinaire est engagé. L’objectif de cette étude était de réaliser une évaluation des pratiques en France métropolitaine concernant les consultations transitionnelles dans le domaine de la neuro-urologie. Afin de réaliser une évaluation des pratiques, un questionnaire a été élaboré à partir du site FRAMAFORMS.org. Le questionnaire a été diffusé de fin novembre 2020 à fin mars 2021 en passant par le Groupe d’Étude en Neuro-Urologie de la Langue Française (GENULF), le comité de neuro-urologie de l’Association Française d’Urologie (AFU) et également la Société Francophone d’Urologie Pédiatrique et de l’Adolescent. Au total, 36 médecins spécialisés de l’adulte ont été contactés via les associations du GENULF et de l’AFU. Le nombre de médecins pédiatriques n’a pu être déterminé. Après analyse des données, 38,7 % des personnes interrogées étaient des urologues adultes spécialisées en neuro-urologie, 22,6 % des urologues pédiatres membres de la SFUPA, 22,6 % des médecins rééducateurs adultes, 3 % des rééducateurs pédiatriques. Quatre-vingt-quatre pourcent du panel exerçait en CHU. Trente-cinq pourcent des personnes interrogées effectuent leurs consultations de transition avec au moins 1 urologue adulte spécialisé, un médecin rééducateur adulte et un chirurgien pédiatrique, 29 % estimaient ne faire ces consultations transitionnelles qu’entre urologues pédiatriques et adultes. Vingt-neuf pourcent des premières consultations transitionnelles étaient effectuées avant l’âge de 15 ans mais 9,7 % des premières consultations avaient lieu à 18 ans ou plus bien plus tard si le patient était perdu de vue. Enfin 54,8 % du panel s’estimait complètement satisfait ou en grande partie de ces consultations transitionnelles. Les barrières évoquées à ces consultations transitionnelles sont nombreuses : manque de disponibilité des certains intervenants notamment des urologues adultes intéressés par la surspécialisation en neuro-urologie, le manque de plages de consultations disponibles dans les CHU, incohérences des pratiques entre chirurgiens pédiatriques et les urologues adultes. Il pourrait être proposé une uniformisation de ces consultations au sein de la métropole.

Male congenital urethral fistula is an extremely rare condition. It is characterized by an abnormal opening of the ventral aspect of the penis. We report the case of a 1-month-old boy with congenital urethral fistula. We will describe the surgical technique, postoperative results, and literature review.

Introduction: Wilms’ tumor (WT), or nephroblastoma, is the most common type of malignant kidney tumor in children. The surgical phase is a key stage in WT management. The main objective of this study was to determine the feasibility of WT segmentation and 3D reconstruction. The secondary objective was to assess the usefulness of these 3D reconstructions in the surgical planning phase and in the selection of patients for nephronsparing surgery. Materials and Methods: 14 scans from 12 patients were manually or semi-automatically segmented by 2 teams using 3D Slicer software. 3D reconstructions were then generated from the segmented images. Inter-individual variability was measured based on the Dice index. The pre-chemotherapy scan (at diagnosis) and the post-chemotherapy scan (before surgery) were segmented for 2 patients in order to measure the tumor volume reduction. The utility of 3D reconstructions for the surgical planning phase was evaluated by 4 pediatric surgeons using a 5-point Likert scale. The possibility of undertaking nephron-sparing surgery was evaluated according to the criteria defined in the UMBRELLA SIOP-RTSG 2016 protocol. Results: Segmentation of the renal tumor, healthy kidney, pathological kidney, arterial and venous vascularization could be performed for all of the patients in this study. Urinary cavities segmentation could only be performed for 5 out of 14 scans that had a delayed acquisition phase. The mean time required to carry out these segmentations was 8.6 hours [3-15 hours]. The mean Dice index for all of the scans was 0.87 [0.83-0.91]. The mean Dice indices for each anatomical structure were 0.95 [0.91-0.97] for the renal tumor, 0.87 [0.69-0.96] for the pathological kidney, 0.95 [0.93-0.96] for the healthy kidney, 0.84 [0.74-0.91] for the arterial vascularization, and 0.77 [0.58-0.86] for the venous vascularization. All the surgeons who were interviewed agreed that the 3D reconstructions were realistic representations and useful for the surgical planning phase. The images reconstructed in 3D allowed most of the criteria defined by the Umbrella SIOP-RTSG 2016 protocol to be evaluated regarding the selection of patients who could benefit from a conservative surgery. Conclusion: Three-dimensional representation appears to assist surgeons with the surgical planning phase by allowing them to better anticipate the operative risks. 3D reconstructions can also be an additional tool to better select patients for nephron-sparing surgery. However, the manual or semi-automatic method used is very time-consuming, making it difficult for a routinely use. Developing techniques to automate this segmentation process, therefore, appears to be essential if surgeons and radiologists are to use it in daily practice.