3D surgical navigation contributes to renal function preservation during robot-assisted partial nephrectomy

Robot-assisted partial nephrectomy (RAPN) requires a precise resection plane to minimize parenchymal loss while preserving oncological safety. A 3D virtual navigation system showed precision advantages in a prior phase I study. We aimed to validate these findings in an expanded cohort and examine whether benefits differ by tumor complexity. In this single-center cohort study, 30 consecutive patients prospectively enrolled to undergo navigation-assisted RAPN (2024-2025) were matched with historical controls (2017-2022) by selecting two patients with the nearest clinical tumor size per case, following exact matching for RENAL nephrometry score. The primary endpoint was excess resected parenchyma (resected specimen volume minus tumor volume); secondary endpoints were 3-month declines in serum eGFR and DTPA-measured ipsilateral GFR. Outcomes were compared overall and by complexity subgroup. After matching, baseline characteristics were well balanced. Excess resected parenchyma was significantly lower in the navigation group (2.7 vs. 6.2 cm³, p = 0.013), and this difference persisted after multivariable adjustment for surgical approach, RENAL nephrometry score, and clinical tumor size (β = -3.39 cm³, 95% CI -6.05 to -0.73; p = 0.013). Lower serum eGFR decline (6.0% vs. 10.8%) and DTPA-measured ipsilateral GFR decline (21.4% vs. 26.0%) in the navigation group were observed but neither difference reached statistical significance. No intraoperative complications or positive surgical margins occurred in either group. The reduction in excess resected parenchyma appeared greater in the high-complexity subgroup (Navigation n = 2, Control n = 4; 2.7 vs. 8.9 cm³) than in the low-complexity subgroup (1.7 vs. 4.3 cm³); however, the group × complexity interaction was not statistically significant (p > 0.1). Navigation-assisted RAPN significantly reduced excess parenchymal resection, an anatomical surrogate of long-term renal function preservation. A possible trend toward greater benefit in higher-complexity tumors observed in our study warrants confirmation in larger, complexity-stratified, multicenter studies.