Impact of 3D Virtual Modeling on Perioperative Outcomes in Robot-Assisted Partial Nephrectomy

Background/Objectives: Robot-assisted partial nephrectomy (RAPN) remains a technically demanding procedure, associated with a non-negligible risk of perioperative complications. This study aimed to assess the impact of preoperative planning and intraoperative navigation using patient-specific three-dimensional (3D) virtual model reconstructions on perioperative outcomes of RAPN. Methods: We analyzed 307 patients who underwent RAPN for renal tumors at a tertiary center between 2021 and 2024. Starting in 2023, 3D modeling (Medics3D) was integrated for selected cases (n = 69) and compared to a 2D-imaging control group (n = 238). The primary outcome was trifecta achievement, defined as the simultaneous presence of negative surgical margins, ≥90% preservation of preoperative eGFR at discharge, and absence of perioperative complications. Clamping strategies were categorized as on-clamp, selective/super-selective, or off-clamp. Mann-Whitney and Chi-squared tests compared the groups; multivariable logistic regression identified independent predictors of trifecta achievement. Results: Baseline characteristics were balanced between the 3D and control groups: median age (62 vs. 61 years, p = 0.5), BMI (28 vs. 26, p = 0.3), and eGFR (85 vs. 86 mL/min/1.73 m², p = 0.5). Median tumor size was 4.2 vs. 4.0 cm (p = 0.4), and RENAL complexity was comparable (p = 0.12). Selective or super-selective clamping was significantly more frequent in the 3D group (32% vs. 15%; p < 0.01). While WIT (17.5 vs. 18.5 min, p = 0.09) and complication rates (26% vs. 29%, p = 0.7) were similar, the 3D group showed a significantly lower rate of positive surgical margins (5% vs. 15%; p = 0.030). Trifecta achievement was significantly higher in the 3D group (51% vs. 32%; p = 0.004). On multivariable analysis, 3D modeling remained an independent predictor of trifecta achievement (OR 2.1, 95% CI 1.17-3.70; p = 0.013). Conclusions: The use of patient-specific 3D kidney reconstructions was associated with improved perioperative outcomes in patients undergoing RAPN. These findings support the integration of 3D modeling into routine surgical workflows to enhance operative precision and optimize patient outcomes.