Application of three-dimensional visualization reconstruction and digital virtual diagnosis and treatment technology in robot-assisted laparoscopic partial nephrectomy for complex renal tumors: a single-center retrospective study.

objectiveTo explore the value of three-dimensional visual reconstruction technology and virtual diagnosis and treatment technology in robot-assisted laparoscopic partial nephrectomy (RAPN) for complex renal tumors (R.E.N.A.L. score ≥ 7).

methodsA retrospective analysis was conducted on the clinical data of 60 patients scheduled to undergo RAPN for complex renal tumors at Hefei Second People’s Hospital between January 2021 and January 2025 and confirmed by postoperative pathological examination. The patients were divided into two groups: the 3D group (n = 30), which underwent three-dimensional visual reconstruction and virtual diagnosis and treatment technology for preoperative planning, and the 2D imaging group (n = 30), which underwent preoperative planning using enhanced CT and enhanced MRI. The following parameters were compared between the two groups: preoperative data (gender, age, body mass index, tumor diameter, R.E.N.A.L. score, laterality, and tumor location); intraoperative and postoperative indicators (total operation time, warm ischemia time, intraoperative blood loss, hemoglobin change, postoperative hospital stay, duration of drain retention, total cost, and blood transfusion rate); renal function change indicators (changes in serum creatinine and glomerular filtration rate preoperatively and at 1, 3, and 6 months postoperatively); and surgical complications (bleeding, subcutaneous emphysema, urinary leakage, intestinal injury).

resultsThere were no significant differences in the baseline characteristics (including age, gender, BMI, tumor laterality, tumor diameter, and R.E.N.A.L. score) between the two groups(P>0.05). Regarding surgical parameters, the 3D reconstruction group showed superior outcomes compared to the 2D imaging group, with statistically significant differences observed in the following metrics༈P<0.05༉: operative time (135.70 ± 18.41 min vs. 142.37 ± 14.25 min, P = 0.025), warm ischemia time (24.67 ± 5.48 min vs. 28.07 ± 5.92 min, P = 0.013), intraoperative blood loss (85.03 ± 25.23 mL vs. 99.67 ± 30.03 mL, P = 0.025), and hemoglobin change (6.97 ± 2.48 g/L vs. 8.67 ± 3.26 g/L, P = 0.022). The 3D reconstruction group showed favorable, though not statistically significant༈P>0.05༉, trends in the following parameters compared to the 2D imaging group: tumor resection time (11.27 ± 2.77 min vs. 12.80 ± 3.73 min, P = 0.059), postoperative hospital stay (7.70 ± 1.91 days vs. 8.57 ± 2.03 days, P = 0.063), time to drain removal (5.83 ± 1.15 days vs. 6.23 ± 1.17 days, P = 0.159), change in serum creatinine levels (11.20 ± 4.28 µmol/L vs. 12.53 ± 4.22 µmol/L), and change in glomerular filtration rate (14.33 ± 3.13 mL/min vs. 16.07 ± 3.77 mL/min). Regarding postoperative complications, no statistically significant difference was found between the two groups༈P>0.05༉. In the 3D group, complications included 2 cases of bleeding and 1 case of subcutaneous emphysema, with no instances of urinary leakage or intestinal injury. The 2D group had 1 case of urinary leakage, 2 cases of bleeding, 1 case of subcutaneous emphysema, and 2 cases of intestinal injury. In the 3D group, one patient with postoperative urinary fistula was classified as Clavien-Dindo grade IIIa, managed by ureteral stent placement under local anesthesia. Two patients with postoperative hemorrhage in the 3D group and two in the 2D group were classified as Clavien-Dindo grade IIIa, treated with arterial embolization in the interventional department. One patient in the 3D group and one in the 2D group were classified as Clavien-Dindo grade I, managed by clinical observation. One patient with intestinal injury in the 2D group was classified as Clavien-Dindo grade II, treated with antibiotic therapy for infection control. In the long-term renal function change indicators of the two groups of patients, data collection was limited to the 1st, 3rd, and 6th months post-surgery due to the follow-up period constraints. The changes in serum creatinine levels at 1 month postoperatively in the 3D reconstruction group (12.67 ± 4.40 µmol/L vs. 13.07 ± 3.82 µmol/L, P = 0.543), the changes in glomerular filtration rate at 1 month postoperatively (13.20 ± 3.07 ml/min vs. 14.70 ± 3.48 ml/min, P = 0.079), the changes in serum creatinine levels at 3 months postoperatively (7.60 ± 3.58 µmol/L vs. 8.50 ± 4.81 µmol/L, P = 0.467), the changes in glomerular filtration rate at 3 months postoperatively (7.00 ± 2.32 ml/min vs. 8.60 ± 3.28 ml/min, P = 0.053), the changes in serum creatinine levels at 6 months postoperatively (8.13 ± 1.70 µmol/L vs. 9.13 ± 2.71 µmol/L, P = 0.155), and the changes in glomerular filtration rate at 6 months postoperatively (7.17 ± 2.68 ml/min vs. 7.83 ± 2.57 ml/min, P = 0.482) showed no statistically significant differences༈P>0.05༉.

conclusionThe application of three-dimensional visual reconstruction and digital virtual diagnosis and treatment technology in RAPN for complex renal tumors can reduce operative time and warm ischemia time, decrease intraoperative blood loss, and shows certain value in enhancing surgical safety. Furthermore, the use of 3D visualization technology improves surgical efficiency without increasing the rate of postoperative complications, representing a safe and effective methodology.