Surgical navigation preserves renal parenchyma in robot-assisted partial nephrectomy

Surgical navigation improves renal parenchyma volume preservation in robot-assisted partial nephrectomy, potentially contributing to recovery in postoperative renal function, suggests a study.

The investigators developed surgical navigation with registration between real-time endoscopic images using 3-dimensional virtual reality models for robot-assisted partial nephrectomy and retrospectively analysed surgical outcomes of 44 (nonsurgical navigation group) and 102 (surgical navigation group) patients between June 2013 and December 2018. Propensity-score matching was carried out to adjust for potential baseline confounders.

Volumetric analysis was used to assess and compare renal parenchymal preservation rate and extraparenchymal volume with a tumour including functional and oncological outcomes (“trifecta” defined as warm ischaemia time of <25 minutes, no complications and negative surgical margins; “pentafecta” defined as trifecta plus >90 percent preservation of estimated glomerular filtration rate at 12 months postoperatively and chronic kidney disease up staging).

Each group had 42 participants after matching. No significant between-group differences were observed in baseline characteristics, complications; and intraoperative, trifecta, and pentafecta outcomes. In contrast, significant between-group differences were noted in pathological T stages (T1a/T1b/T2a or more 25/10/7 in the nonsurgical navigation group vs 35/7/0 in the surgical navigation group; p=0.003).

The surgical navigation group had significantly higher extraparenchymal volumes (21.4 vs 17.2 ml; p=0.041) and parenchyma volume preservation rates (90.0 percent vs 83.5 percent; p=0.042). In addition, surgical navigation positively correlated with improved parenchyma preservation volume (p=0.003).