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3D virtual model for robot-assisted partial nephrectomy in highly-complex cases (PADUA ⩾ 10).

Antonio Andrea Grosso1, Fabrizio Di Maida1, Luca Lambertini1

  • 1Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic, Minimally-invasive Urology and Andrology, Careggi Hospital, Florence, Italy.

Urologia
|May 21, 2024
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Summary

Robot-assisted partial nephrectomy (RAPN) using 3D virtual models (3DVMs) improved functional outcomes for complex kidney masses. This technology reduced global ischemia and enhanced enucleation rates, showing positive impacts at 12 months.

Keywords:
Augmented realitypartial nephrectomyrenal cancerrobotic surgerythree-dimensional models

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Area of Science:

  • Urology
  • Surgical Technology
  • Nephrology

Background:

  • Robot-assisted partial nephrectomy (RAPN) is a standard treatment for renal masses.
  • Highly-complex renal masses (PADUA score ≥10) present surgical challenges.
  • The role of advanced visualization tools like 3D virtual models (3DVMs) in RAPN for complex cases requires further investigation.

Purpose of the Study:

  • To compare functional, perioperative, and oncological outcomes of RAPN for highly-complex renal masses (PADUA ≥10) with versus without 3DVM assistance.
  • To evaluate the superiority of RAPN with 3DVMs in terms of renal functional outcomes at 12 months post-surgery.
  • To identify the impact of 3DVMs on selective clamping, enucleation rates, and preservation of kidney function.

Main Methods:

  • A prospective cohort study comparing 152 patients undergoing RAPN with 3DVMs and 1264 patients without 3DVMs (2019-2022).
  • Analysis included only highly-complex renal masses (PADUA score ≥10).
  • Propensity score matching (PSM) was used to create comparable cohorts (37 patients each) for analysis. Multivariable logistic regression (MVA) assessed factors associated with eGFR drop.

Main Results:

  • The 3DVM group showed a higher rate of selective/no clamping (32.5% vs 16.2%, p=0.03) and enucleation (43.2% vs 29.8%, p=0.04).
  • At 12 months, the 3DVM group demonstrated better renal function preservation, with lower serum creatinine and higher estimated glomerular filtration rate (eGFR) (p=0.03 for both).
  • MVA confirmed 3DVMs as a protective factor against significant eGFR drop in this patient subgroup.

Conclusions:

  • RAPN with 3DVM assistance for PADUA ≥10 renal masses leads to reduced global ischemia and increased enucleation rates.
  • The use of 3DVMs in RAPN for complex renal masses positively impacts renal function preservation at 12-month follow-up.
  • 3DVMs represent a valuable technological advancement for improving outcomes in complex partial nephrectomies.