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This research evaluates how 3D virtual modeling affects results during robot-assisted partial nephrectomy.

April 7, 2026Open Access

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

FPFrancesco PassaroIstituto Nazionale Tumori IRCCS "Fondazione G. Pascale"AAAchille AvetaCeinge Biotecnologie Avanzate (Italy)GSGianluca SpenaIstituto Nazionale Tumori IRCCS "Fondazione G. Pascale"

Key Points

This research evaluates how 3D virtual modeling affects results during robot-assisted partial nephrectomy.
Analyzed 307 patients undergoing robot-assisted partial nephrectomy from 2021 to 2024.
Compared outcomes between a control group using 2D imaging and a 3D modeling group (69 patients).
Assessed trifecta achievement as primary outcome, including surgical margins and kidney function preservation.
3D group achieved a trifecta rate of 51% compared to 32% in the control group (p = 0.004).
Lower positive surgical margins in the 3D group (5% vs. 15%; p = 0.030).
Selective clamping strategies were more frequent in the 3D group (32% vs. 15%; p < 0.01).

Abstract

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.

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