Three-dimensional virtual models accurately predict preserved parenchymal volume after robot-assisted partial...

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Accurate prediction of postoperative renal function after robot-assisted partial nephrectomy (RAPN) is challenging.
• Preserved parenchymal volume (PPV) is crucial for long-term renal function.
• Three-dimensional virtual models (3DVM) offer patient-specific anatomical reconstruction for volumetric quantification.

Purpose of the Study:

• To prospectively validate the accuracy of 3DVM in predicting postoperative PPV after RAPN.
• To assess the relationship between 3DVM-predicted PPV and actual postoperative renal function.
• To explore the correlation between 3DVM-based PPV and anatomical complexity scores (PADUA, RENAL).

Main Methods:

• Prospective single-center study of patients undergoing RAPN with preoperative 3DVM planning.
• Comparison of estimated preoperative PPV from 3DVM with real postoperative PPV from follow-up 3DVM.
• Correlation analysis of PPV with functional outcomes (serum creatinine, eGFR) and tumor complexity scores (PADUA, RENAL).

Main Results:

• Strong correlation between estimated and real postoperative PPV (ρ = 0.97, p < 0.0001), with a mean absolute difference of ~6%.
• The PADUA score negatively correlated with postoperative eGFR (ρ ≈ -0.4, p < 0.05).
• Median parenchymal loss was 6% with low surgical morbidity (17% Clavien I-II).

Conclusions:

• 3DVM provide accurate predictions of postoperative PPV after RAPN, demonstrating high concordance with volumetric measurements.
• Integration of 3D volumetry into surgical planning can enhance nephron-sparing strategies.
• 3DVM serve as a valuable quantitative tool for optimizing functional preservation in RAPN.