A journey into the Uroverse for robotic partial nephrectomy

The Metaverse is an immersive environment blending virtual and physical realms. Its application in healthcare and surgery is raising ever more interest. A pioneering experience already investigated surgical planning for partial nephrectomy (PN) within the metaverse, using virtual 3D models. Herein we present the first experience of a Uroverse navigation during robot-assisted PN (RAPN), obtained thanks to further refinements in 3D models’ creation and the metaverse experience. Specifically for this study, carried out during the 12 th Techno Urology Meeting, the metaverse experience was improved in three main aspects and called “Uroverse”. First, 3D models reached an unprecedented fidelity and were called “digital twin”. Secondly, the metaverse experience was even more immersive, with avatars replicating users’ aspect and the environment reproducing a surgical theater. Finally, preoperative navigation was performed using new headsets, optimizing the interaction with the models, and the Uroverse experience was also integrated into the robotic console using the Tile Pro for intraoperative consultation. Thanks to this technology, surgeons and moderators were able to virtually meet in the same room, even if physically distant. Seven patients underwent RAPN after surgical planning in the metaverse. The median time for metaverse discussion was 8 min (IQR 8–9). According to digital twin models, the clamping strategy during the intervention was global in 4 patients (57,2%) and selective in 3 patients (42,8%). Enucleation and enucleoresection were performed in 3 (42,8%) and 4 (57,2%) cases, respectively. Selective management of intraparenchymal structures, as suggested by digital twin, was performed in 4 cases. The median warm ischemia time was 12 min (IQR 10–16,5). No intraoperative complications occurred; 3 postoperative complications were observed. All the patients had negative surgical margins. The Uroverse experience for preoperative surgical planning and intraoperative navigation was effective and widely appreciated by surgeons.