Three-dimensional virtual models (3DVMs) have emerged as a promising tool to enhance both surgical precision and functional outcomes in complex robot-assisted partial nephrectomies (RAPN). This study aimed to compare perioperative and functional outcomes between two cohorts of patients undergoing RAPN for totally endophytic renal tumors, with and without the use of 3DVMs.
A retrospective analysis on a prospectively maintained dataset was conducted on 277 patients treated between 2019 and 2022, including 43 who underwent surgery with 3DVM assistance and 234 who relied on conventional two-dimensional (2D) imaging. Propensity-score matching (PSM) analysis using a 2:1 ratio was conducted to reduce selection bias. The primary outcome was achieving the "trifecta". Predictors of trifecta achievement were analyzed using multivariate logistic regression.
After PSM, 43 patients in the 3DVM group were compared with 86 patients in the control group. Baseline patient- and tumor-related characteristics were similar between groups. Selective clamping was exclusively performed in the 3DVM group (16.3% vs. 0%, P=0.01). Global ischemia time was found significantly shorter in the 3D-guided group (median 10 vs. 14 min; P=0.01). Positive surgical margins (6.9% vs. 7.3%) did not differ significantly. Trifecta was achieved more frequently in the 3DVM group (76.7% vs. 68.2%, P=0.04). Multivariate analysis confirmed 3DVMs as an independent predictor of trifecta success (OR 1.58; 95% CI 1.12-1.99).
For totally endophytic renal tumors, 3DVM integration facilitated selective clamping and improved trifecta attainment, reinforcing its role in optimizing outcomes in complex nephron-sparing surgery.
Minerva urology and nephrology. 2026 Feb [Epub]
Antonio A Grosso, Fabrizio DI Maida, Luca Lambertini, Giulia Carli, Marco Saladino, Francesco L Conte, Vincenzo Salamone, Francesca Conte, Neliana Kucuku, Filippo Lipparini, Daniele Paganelli, Sofia Giudici, Rino Oriti, Riccardo Fantechi, Matteo Salvi, Gianni Vittori, Andrea Minervini, Andrea Mari
Unit of Oncologic, Minimally-Invasive Robotic Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy - ., Unit of Oncologic, Minimally-Invasive Robotic Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy.