Three-dimensional Models for Individualized Preoperative Planning of Robot-assisted Partial Nephrectomy in Patients...

Renal tumors in horseshoe kidneys (HSKs) present unique surgical challenges because of complex vascular anatomy, limited organ mobility, and the proximity of critical structures. We report a European multicenter case series of 24 patients with HSK tumors who underwent robot-assisted partial nephrectomy that was planned with patient-specific three-dimensional (3D) virtual models. Reconstructions were generated from multiphase computed tomography scans, which allowed detailed vascular mapping and tailored ischemia strategies. The median tumor size was 5.4 cm, with a median of three renal arteries per patient. A clampless approach was achieved in 12 cases (50%), including five with anatomic devascularization via ligation of tumor-specific segmental arteries. When clamping was required (n = 12), the median warm ischemia time was 23 min. There were no conversions to open surgery and no local recurrences. Major complications occurred in two patients (8.3%) and the median decline in estimated glomerular filtration rate was -5.0 ml/min/1.73 m² at last follow-up. Trifecta outcomes (negative surgical margin, no major complications, and renal function ≥90% of the baseline value) were achieved in 50% of cases. This series highlights the role of 3D surgical planning in optimizing vascular control, facilitating nephron-sparing techniques, and preserving renal function in these anatomically highly complex procedures.