Impact and costs of 3D virtual models in minimally invasive partial nephrectomy: a propensity score-matched analysis.

BACKGROUND: Three-dimensional (3D) virtual models are increasingly used to support minimally invasive partial nephrectomy (PN), but their clinical value remains uncertain. We assessed whether 3D guidance improves perioperative, oncological, and early functional outcomes and evaluated its cost. METHODS: We retrospectively analyzed 159 patients who underwent laparoscopic or robot-assisted PN between 2022 and 2024. Propensity score matching generated two comparable groups (35 patients each) treated with or without 3D virtual model guidance, according to age, PADUA score, and surgical approach. Perioperative, pathological, early oncological, and early functional outcomes were compared using non-parametric tests. RESULTS: Although matching improved comparability, some residual imbalance remained. The 3D group had longer operative times (median 200 vs 170 min; p=0.008). No significant differences were found in clamping strategy, warm ischemia time, estimated blood loss, hospital stay, pathological stage, surgical margins, postoperative complications, or early recurrence. Changes in haemoglobin, serum creatinine, and estimated glomerular filtration rate from baseline to discharge were similar between groups. Each 3D virtual model cost €800. CONCLUSIONS: In this propensity score-matched cohort, 3D virtual model guidance during minimally invasive PN was associated with longer operative time, added cost, and no measurable benefit in perioperative, oncological, or early functional outcomes.