The clinical application value of mixed reality guidance in robot-assisted laparoscopic radical nephrectomy for renal cancer.

Abstract

Although robot-assisted laparoscopic radical nephrectomy (RAL-RN) has realized the benefits of minimally invasive surgery, it continues to face several key technical limitations, including the lack of integrated patient-specific three-dimensional anatomical navigation and insufficient real-time intraoperative navigation. While mixed reality (MR) technology has shown considerable potential in renal tumor surgery, its clinical application value specifically within the context of radical nephrectomy for renal cancer warrants further systematic evaluation. This study aims to evaluate the clinical efficacy and practical value of MR guidance in RAL-RN. A retrospective analysis was conducted of 74 patients who underwent RAL-RN between September 2021 and March 2024. Participants were categorized into two groups based on preoperative assessment methodology: an MR navigation group (n = 33) and a conventional imaging group (n = 41). All patients received non-contrast and triple-phase contrast-enhanced renal CT scans. The MR group utilized Hololens-based intraoperative anatomical reference with three-dimensional models reconstructed from preoperative CT data during Da Vinci robotic procedures. Perioperative outcomes, including baseline demographic and clinical characteristics, operative time, estimated blood loss, and postoperative complications, were compared between the two groups to assess the potential technical advantages of MR-guided navigation. The two groups showed comparable baseline characteristics (p > 0.05). The MR group exhibited significantly shorter operative time (161.15 ± 10.87 min versus 182.29 ± 12.40 min, p < 0.001), reduced blood loss (150.00 mL [interquartile range 140.00 to 165.00] versus 165.00 mL [150.00 to 165.00], p = 0.008), faster gastrointestinal function recovery (26.82 ± 4.17 h versus 28.93 ± 3.68 h, p = 0.024), earlier tube removal (5.00 days [4.00 to 5.00] versus 6.00 days [6.00 to 7.00], p < 0.001), and shorter postoperative hospitalization (6.00 days [6.00 to 7.00] versus 8.00 days [7.00 to 8.00], p < 0.001). No significant differences were observed in tumor staging, renal function parameters (postoperative and 12-month Scr and GFR), histopathological type, or complication rates (Clavien-Dindo grades 1 and 2) between groups (all p > 0.05). MR guidance was associated with shorter operative time and faster postoperative recovery in RAL-RN. However, given the non-randomized design, these findings should be regarded as preliminary and cannot establish causality. Prospective studies with standardized allocation and adequate follow-up are warranted to confirm the clinical value of MR guidance.