Comparing different 3D virtual models generations for the planning of robotic partial nephrectomy: the added value of perfusion volumes implement.

Introduction: The aim of the study is to evaluate the role of a new generation of 3D virtual models (3DVM) implemented with perfusion volumes algorithm, in influencing perioperative and functional outcomes after robotic partial nephrectomy (RAPN).

Methods: A perfusion volume 3DVM was built using Voronoi diagram-based algorithm for all the organ-confined renal masses candidate for RAPN from 12/2019 to 12/2022. On its basis, a selective or super-selective clamping was planned. A sub-cohort of patients underwent renal scintigraphy (RS), evaluating estimated renal plasmatic flow (ERPF). Data were compared with a retrospectively selected control group in which the surgery was assisted by 3DVM without perfusion volume assessment.

Results: 116 and 217 were considered. In 77 (67.5%) and 81 (37.3%) patients a selective or super-selective clamping was performed, in the study and control group respectively (p < 0.001). A higher rate of third-order artery clamping was recorded in the study group (42/77 vs. 26/81, p 0.004). No difference was found in terms of postoperative complications (overall postoperative: 17.2% and 19.3%; major complications: 3.4% and 3.2%). Clamping strategy failure was recorded in 5 (4.3%) and 26 (11.9%) (p 0.02). A significant ERPF drop (> 20%) was recorded in 3/51 (5.8%) and 16/82 (19.5%) patients in study and control group, respectively (p 0.04). Similarly, median delta ERPF resulted different between the groups (-10.69% vs. -18.92%, p < 0.001).

Conclusions: Perfusional volumes 3DVMs, lead the surgeon to perform a higher rate of effective selective and super-selective clampings, translating in higher rates of renal units functionally saved.