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Three-dimensional virtual model for robot-assisted partial nephrectomy: a propensity-score matching analysis with a
Antonio Andrea Grosso1, Fabrizio Di Maida2, Luca Lambertini2
1Department of Experimental and Clinical Medicine, Minimally-Invasive Urology and Andrology, University of Florence-Unit of Oncologic, Careggi Hospital, San Luca Nuovo, 50134, Florence, Italy. grossoantonioandrea@gmail.com.
World Journal of Urology
|May 20, 2024
Summary
Robot-assisted partial nephrectomy (RAPN) using three-dimensional virtual models (3DVMs) improves functional outcomes and enucleation rates, particularly for high-risk renal masses. This technology reduces global ischemia incidence in RAPN procedures.
Area of Science:
- Urology
- Surgical Technology
- Nephrology
Background:
- Robot-assisted partial nephrectomy (RAPN) is a standard procedure for kidney tumor removal.
- The integration of three-dimensional virtual models (3DVMs) in RAPN aims to enhance surgical precision and patient outcomes.
- Assessing the impact of 3DVMs on functional and oncological results is crucial for optimizing surgical techniques.
Purpose of the Study:
- To compare the functional and oncological outcomes of robot-assisted partial nephrectomy (RAPN) performed with and without three-dimensional virtual models (3DVMs).
- To evaluate the specific benefits of 3DVMs in different risk categories of renal masses.
Main Methods:
- A prospective cohort study comparing 100 patients undergoing RAPN with 3DVMs and 100 patients undergoing RAPN without 3DVMs, matched using propensity score analysis (PSMA).
- Evaluation of primary endpoint: 12-month functional outcomes (serum creatinine and eGFR).
- Secondary endpoints included perioperative and oncological outcomes, with multivariable logistic regression (MVA) and subgroup analysis based on PADUA-risk categories.
Main Results:
- RAPN with 3DVMs showed a higher rate of selective/no clamping (32% vs. 16%) and enucleation (40% vs. 29%).
- Improved 12-month functional preservation was observed in the 3DVM group (eGFR: 64.6 vs. 52.3), particularly for high-risk renal masses (PADUA ≥ 10).
- No significant differences were found in secondary perioperative or oncological outcomes between the groups.
Conclusions:
- Three-dimensional virtual model-assisted RAPN leads to reduced global ischemia and increased enucleation rates.
- The functional benefits of 3DVMs in RAPN are most pronounced at 12 months post-surgery and are specifically associated with high-risk renal masses.
- 3DVMs serve as a protective factor against significant eGFR decline in patients with high-risk renal masses undergoing RAPN.
