Impact of three-dimensional reconstruction on ischaemic time and operative time in robot-assisted partial nephrectomy

Partial nephrectomy (PN) is the standard treatment for T1a renal masses, increasingly applied to T1b tumours due to advancements in robotic surgery and imaging. While CT urograms are standard, three-dimensional (3D) reconstruction is gaining traction for complex tumours to enhance preoperative planning. This study aimed to compare the impact of 3D reconstruction on operative time and ischaemic time during robot-assisted PN.

A prospective, non-randomised study was conducted on 112 patients who underwent robot-assisted PN between January 2020 and October 2022. Patients were divided into two groups: Group A (n=56) with the aid of 3D reconstruction for complex tumours and Group B (n=56) without 3D reconstruction. Operative time and ischaemic time were analysed, along with other outcomes such as margin positivity and postoperative complications.

Despite higher tumour complexity in Group A, mean operative time (190.1 [standard deviation, SD 38.5] min vs. 189.3 [SD 42.6] min) and mean ischaemic time (20.4 [SD 5.6] min vs. 20.3 [SD 5.3] min) were comparable between Group A and Group B. Margin positivity and complications were also similar, suggesting that 3D reconstruction aids in efficient surgery even for complex cases.

3D reconstruction enhances understanding of complex renal tumours, maintaining operative efficiency comparable to less complex cases. Further randomized studies are needed to confirm these findings.