Augmented Reality to Guide Selective Clamping and Tumor Dissection During Robot-assisted Partial Nephrectomy: A Preliminary Experience

Three-dimensional (D) models can be used as addi-tional preoperative tools to improve the understandingof the size, location, depth of a renal mass andvascular anatomy before robot-assisted partial ne-phrectomy (RAPN).During RAPN, the augmented reality (AR) technologywith overlapping of 3D models inside the roboticconsole, can facilitate a fast and accurate anatomicidentification of the renal vasculature and tumoranatomy in a real-time manner.The 3D-guided approach with AR during RAPN allows surgeon to perform selective and super-selectiveclamping in higher proportion of cases comparedwith conventional planning based on 2D imaging.The effective intraoperative management of renal hi-lum guided by AR guidance was performed as pre-operatively planned in 86.7% of patients.Three-D models were more accurate than 2D standardimaging to evaluate the surgical complexity of renal masses according to nephrometry scores.The use of AR for 3D-guided renal surgery is useful to improve the intraoperative knowledge of renal anatomy with higher adoption of selective and super-selective clamping approach and safe surgical outcomes.