Hevia Vital, García-Rojo Esther, Brime-Menéndez Ricardo, Pérez-Ruiz José Miguel, Belkahia Ghali, Paesano Nahuel, Barrientos Facundo, Duque-Ruiz Gemma, Lista-Mateos Fernando, Justo-Quintas Juan, Romero-Otero Javier
Department of Urology, ROC Clinic HM Hospitales, Madrid, Spain.
Department of Urology, ROC Clinic HM Hospitales, Paseo del General Martinez Campos 17, 1B, Madrid, 28010, Spain.
Curr Urol Rep. 2025 Aug 8;26(1):60. doi: 10.1007/s11934-025-01288-y.
Robot-assisted partial nephrectomy (RAPN) has become the gold standard for treating localized renal cell carcinoma (RCC) in high-volume centres. However, increasing tumor complexity demands refined preoperative planning tools. This review summarizes current evidence regarding the use of three-dimensional virtual models (3DVM) in RAPN, focusing on their clinical applications, outcomes and future perspectives.
3DVMs are generated from contrast-enhanced CT scans through segmentation and reconstruction, enabling interactive anatomical visualization. These models provide functional tools such as perfusion territory mapping, volumetric renal function prediction and nephrometry-based complexity stratification. Integration with augmented reality (AR) platforms allows real-time intraoperative navigation. Comparative studies and meta-analyses demonstrate that 3DVM-guided RAPN is associated with reduced warm ischemia time (WIT), lower estimated blood loss (EBL), higher trifecta/pentafecta achievement and improved postoperative renal function, particularly in complex tumors. Additionally, 3DVM enhance surgical education and patient counselling. 3DVM represent a pivotal advancement in personalized urologic surgery. By improving anatomical comprehension, surgical precision, and planning of selective ischemia strategies, they contribute to superior intraoperative and functional outcomes in RAPN. Although promising, broader implementation requires standardization, cost-effectiveness validation and further multicentre prospective studies.
在大型医疗中心,机器人辅助部分肾切除术(RAPN)已成为治疗局限性肾细胞癌(RCC)的金标准。然而,肿瘤复杂性的增加需要更精细的术前规划工具。本综述总结了目前关于三维虚拟模型(3DVM)在RAPN中应用的证据,重点关注其临床应用、结果和未来前景。
3DVM通过分割和重建从增强CT扫描生成,实现交互式解剖可视化。这些模型提供了诸如灌注区域映射、肾体积功能预测和基于肾计量学的复杂性分层等功能工具。与增强现实(AR)平台集成可实现术中实时导航。比较研究和荟萃分析表明,3DVM引导的RAPN与减少热缺血时间(WIT)、降低估计失血量(EBL)、提高三联/五联成功几率以及改善术后肾功能相关,尤其是在复杂肿瘤中。此外,3DVM增强了手术教育和患者咨询。3DVM代表了个性化泌尿外科手术的一项关键进展。通过提高解剖理解、手术精度和选择性缺血策略的规划,它们有助于在RAPN中获得更好的术中及功能结果。尽管前景广阔,但更广泛的应用需要标准化、成本效益验证以及进一步的多中心前瞻性研究。