Role of three-dimensional modelling and augmented reality during robotic-assisted partial nephrectomies

INTRODUCTION: Partial nephrectomy (PN) represents the preferred treatment for most small, localized renal tumors with a size <4 cm. Various augmented reality (AR) tools have been developed to assist surgeons gain a better understanding of each patient’s anatomical and pathological characteristics and subsequently create personalized surgical strategies. One such tool, the three-dimensional (3D) virtual reconstructions from routine preoperative imaging techniques, has become popular. The present study is a narrative review that aims to assess the role of 3D modelling and AR in robotic-assisted PN (RAPN).EVIDENCE ACQUISITION: A literature search was performed in the PubMed library using the key words “three-dimensional,” “3D,” “modelling,” “augmented reality,” “robotic,” “robotic-assisted,” “partial nephrectomy,” “partial nephrectomies” and “RAPN.” Only published human studies written in English language and reporting a robotic-assisted approach were included in the review.EVIDENCE SYNTHESIS: The efficacy of 3D models in enhancing the accuracy of surgical planning during RAPN has been assessed both preoperatively and intraoperatively. Preoperative planning with 3D models advances “specialized medicine” and stops the “one size fits all” approach in surgical procedures. The 3D planning tools, except for optimizing the resection during RAPN, can facilitate more efficient arterial clamping techniques, display the perfusion zones of all arteries and highlight the most appropriate arteries to clamp. AR laparoscopic videos, with updated preoperative images, offer significant benefits as integrating image-guided systems with the Da Vinci robotic platform results in enhanced overall tissue resection and reduced removal of adjacent benign tissue while ensuring adequate surgical margins.CONCLUSIONS: Although the results from existing studies seem promising, further and stronger evidence from randomized controlled studies is deemed necessary to globally validate 3D models and support their integration into everyday clinical practice. Eventually, these developments could enable surgeons to operate more precisely and efficiently, leading to better patients’ outcomes.