Impact of Three-Dimensional Reconstruction on Partial Nephrectomy Outcomes: A Systematic Review and Meta-Analysis

Introduction: Three-dimensional (3D) reconstruction may improve anatomical planning in partial nephrectomy, but its clinical impact remains unclear. This study aims to evaluate the impact of 3D reconstruction on perioperative outcomes in partial nephrectomy. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 (PROSPERO CRD420261373519). PubMed/MEDLINE, EMBASE, Cochrane, and Web of Science were searched. Randomized and nonrandomized studies comparing 3D reconstruction with two-dimensional imaging in adults undergoing partial nephrectomy were included. Pooled estimates were expressed as mean differences (MDs) or risks ratio (RR) with 95% CIs. Subgroup analyses considered tumor complexity, study design, 3D technology, and surgical approach. Results: Twenty-eight studies (3196 patients) were included. 3D reconstruction reduced warm ischemia time (MD −1.31 minutes; p = 0.02), operative time (MD −8.30 minutes; p = 0.0002), and estimated blood loss (MD −18.95 mL; p = 0.006). It also lowered overall complications (RR 0.74; p = 0.006) and global ischemia (RR 0.72; p = 0.005), with higher selective clamping rates (RR 1.96; p = 0.0006). Smaller declines in eGFR (MD −2.02; p = 0.0006), shorter hospital stay (MD −0.32; p ≤ 0.0001), no differences in creatinine or major complications. Benefits were greater in complex tumors, with no differences across technologies or approaches. Prediction intervals for the main outcomes included the null effect, suggesting that these benefits may not be consistently reproduced across different clinical settings. Conclusion: 3D reconstruction may improve perioperative outcomes and trifecta rates in partial nephrectomy, particularly in complex tumors, supporting its potential role in surgical planning. However, prediction intervals indicate that these benefits may not be consistently observed across different clinical settings, highlighting the need for further randomized studies evaluating long-term and cost-effectiveness outcomes.