Surgical planning for minimally invasive Partial Nephrectomy (PN) is intricate, requiring consideration of various patient and tumor characteristics, particularly the tumor’s relationship with renal hilar anatomy. Virtual three-dimensional (3D) models is a promising technology that creates specific 3D printed models based on routine CT or MR imaging data. The objective of this study is to identify the role of 3D reconstruction as part of the preoperative planning process for complex renal tumors.

Four patients with complex renal tumors were retrospectively chosen based on RENAL nephrectomy score and diverse anatomical characteristics from their pre-operative computed tomography (CT) datasets. Interactive virtual 3D models were created for each dataset using image segmentation software and made accessible for viewing and manipulation. A well-planned structured questionnaire was distributed among the attending urologists at an international meeting held in Kochi. The survey questionnaire inquired about demographic data, surgical experience, imaging clarity concerning the arterial, venous, and calyceal system, the feasibility of performing partial PN, surgical approach, time of ischemia, estimated blood loss after viewing CT scans, and their respective 3D models.

60 urologists participated in the study and most of them (86%) were consultants. The overall likelihood of performing PN after viewing the 3D reconstructions significantly increased (2.31±0.32 vs. 2.9±0.39, p<0.001), the probability of conversion to radical nephrectomy significantly decreased (3.9±0.27 vs. 3.38±0.22, p<0.001) Preference for the open approach significantly decreased (p<0.05) along with a decrease in warm ischemia time and estimated blood loss. Surgical decision change was significantly associated with number of partial or radical nephrectomies performed annually.

3D reconstruction models play a significant role in modifying surgeons’ strategies and surgical planning for patients with complex renal tumors.