Impact of 3D-Assisted Preoperative Planning on Surgical and Functional Outcomes of Partial Nephrectomy in Adults: A Systematic Review.

Abstract

Background: Three-dimensional (3D) imaging is used for preoperative planning of partial-nephrectomy, enhancing visualisation of tumour anatomy, vascular structures, and their spatial relationships. This systematic review evaluated the impact of 3D-assisted planning on surgical, perioperative, and functional outcomes in adults undergoing partial-nephrectomy.

Methods: A systematic review was conducted according to PRISMA 2020 guidelines. Eligible studies included adults with clinically localised T1-T2 renal tumours undergoing open, laparoscopic, or robotic partial-nephrectomy, in whom preoperative 3D reconstructions from CT or MRI were compared with conventional two-dimensional planning. Outcomes assessed were positive surgical margins, warm-ischaemia time, postoperative complications, renal function, operative time, estimated blood loss, and hospital stay. Searches of MEDLINE, EMBASE, Cochrane CENTRAL and Web of Science (2015-2025) identified 495 records; after screening and assessment, 9 studies were included.

Results: Nine studies reported surgical and functional outcomes of partial-nephrectomy using 3D technology. Positive surgical margin rates were 0-9%, with only one study demonstrating a significant difference favouring the 3D cohort (0% vs 28%). Renal function outcomes were generally comparable, although one study reported superior eGFR preservation in the 3D cohort (80% vs 70% of baseline; p = 0.02). Warm-ischaemia time ranged from 13.5 to 26 minutes, with a significant reduction reported only by one study (24 vs 28 min; p < 0.01). Operative time showed variations across studies (ranging from 105-212 minutes), with two studies showing significant reductions (e.g., 130 vs 160 min; p < 0.05). Estimated blood loss ranged from 50 to 830 mL, and two studies demonstrated significant reductions with 3D imaging (e.g., 591 vs 141 mL; p = 0.019).

Conclusions: Available evidence suggests that 3D-assisted preoperative planning may be associated with improvements in selected perioperative outcomes, namely operative time, blood loss, and warm-ischaemia time, while maintaining low positive-margin rates and without increasing postoperative complications or impairing renal function. However, findings are inconsistent and based predominantly on non-randomised studies with small-sample sizes and methodological heterogeneity. Larger prospective studies with standardised outcome reporting are required to possibly define with more accuracy the clinical benefits of 3D planning in partial-nephrectomy. The PROSPERO Registration: CRD420251160851. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1160851.