3D augmented reality-guided robotic partial nephrectomy

Abstract

The present study aims to provide a contemporary overview of the use of augmented reality (AR) in robotic renal surgery from the renal pedicle management to the demolition and reconstructive phases thanks also to the preoperative planning obtained with three-dimensional virtual models (3DVMs). Recently, the increasing use of the robotic approach extends the indication to partial nephrectomy also in cases of complex or large renal masses and maximizing functional and surgical outcomes. With this goal, new imaging technologies have increased in popularity, especially for laparoscopic and robotic approaches. In this scenario, hyper-accuracy 3DVMs of the kidney and tumor, based on computed tomography (CT) scans, have been developed as a new tool for preoperative planning and intraoperative surgical navigation via AR technology. However, a standardized production process of 3DVMs and dedicated guidelines on their use and application are still needed. A recent systematic review and metanalysis has shed light on the impact of 3D models on minimally-invasive nephron-sparing surgery (NSS). Specifically, lower rates of global ischemia and collecting system violation were observed within AR-robot-assisted partial nephrectomy (RAPN). However, these rates did not translate into significant improvements in terms of oncological or functional outcomes. This review provides a contemporary overview of the use of AR in robotic renal surgery from the renal pedicle management to the demolition and reconstructive phases thanks also to the preoperative planning obtained with 3DVMs.