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      Robot-assisted partial nephrectomy with 3D preoperative surgical planning: video presentation of the florentine experience


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          Three-dimensional (3D) virtual models have recently gained consideration in the partial nephrectomy (PN) field as useful tools since they may potentially improve preoperative surgical planning and thus contributing to maximizing postoperative outcomes ( 1- 5).

          The aim of the present study was to describe our first experience with 3D virtual models as preoperative guidance for robot-assisted PN.

          Materials and methods:

          Data of patients with renal mass amenable to robotic PN were prospectively collected at our Institution from January to April 2020. Using a dedicated web-based platform, abdominal CT-scan images were processed by M3DICS (Turin, Italy) and used to obtain 3D virtual models. 2D CT images and 3D models were separately assessed by two different highly experienced urologists to assess the PADUA score and risk category and to forecast the surgical strategy of the single cases, accordingly.


          Overall, 30 patients were included in the study. Median tumor size was 4.3cm (range 1.3-11). Interestingly, 8 (26.4%) cases had their PADUA score downgraded when switching from 2D CT-scan to 3D virtual model assessment and 4 (13.4%) cases had also lowered their PADUA risk category. Moreover, preoperative off-clamp, selective clamping strategy and enucleation resection strategy increased from CT-scan to 3D evaluation.


          3D virtual models are promising tools as they showed to offer a reliable assessment of surgical planning. However, the advantages offered by the 3D reconstruction appeared to be more evident as the complexity of the mass raises. These tools may ultimately increase tumor's selection for PN, particularly in highly complex renal masses.

          Disclosure of potential conflicts of interest: The authors declare they do not have conflict of interests.

          Informed consent: Informed consent was obtained from all individual participants included in the study. All the procedures were in accordance with the ethical standards of the institutional and national research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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          Most cited references5

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          Three-dimensional Augmented Reality Robot-assisted Partial Nephrectomy in Case of Complex Tumours (PADUA ≥10): A New Intraoperative Tool Overcoming the Ultrasound Guidance

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            Current Use of Three-dimensional Model Technology in Urology: A Road Map for Personalised Surgical Planning

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              Three-dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores.

              To apply the standard PADUA and RENAL nephrometry score variables to three-dimensional (3D) virtual models (VMs) produced from standard bi-dimensional imaging, thereby creating three-dimensional (3D)-based (PADUA and RENAL) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D-based nephrometry score/category, in order to evaluate their predictive role for postoperative complications.

                Author and article information

                Int Braz J Urol
                Int Braz J Urol
                International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Sociedade Brasileira de Urologia
                20 June 2021
                Nov-Dec 2021
                : 47
                : 6
                : 1272-1273
                [1 ] orgnameUniversity of Florence orgdiv1Unit of Oncologic Minimally-Invasive Urology and Andrology orgdiv2Department of Experimental and Clinical Medicine Florence Italy originalDepartment of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
                Author notes
                Correspondence address: Antonio Andrea Grosso, MD Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital Largo Brambilla, 3, 50134, Florence, Italy. Fax: + 39 055 275-8014 E-mail: grossoantonioandrea@ 123456gmail.com

                CONFLICT OF INTEREST

                None declared.

                Author information

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 09 December 2020
                : 09 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 5, Pages: 2
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