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Pecoraro et al. Mini-invasive Surg 2024;8:25 https://dx.doi.org/10.20517/2574-1225.2023.134 Page 9 of 12

supplying the middle and upper pole of the left kidney.

REAL TIME DYNAMIC IMAGING DURING SURGERY
Hyper-accuracy 3DVMs are valuable for preoperative tumor evaluation and intraoperative navigation, but
their use in real-time dynamic imaging during surgery presents additional challenges. During surgery,
hyper-accuracy 3DVMs assist in guiding the surgeon by overlaying preoperative 3D models onto real-time
imaging. However, real-time dynamic imaging requires continuous updates to reflect changes during
surgery, such as tumor deformation or movement. Conversely, current Technology relies on techniques
such as intraoperative ultrasound, fluoroscopy, or endoscopy. Integrating these with hyper-accuracy
3DVMs requires sophisticated systems that can synchronize the 3D model with real-time changes. These
could be possible only through high-speed data acquisition and processing, along with advanced
computational resources, to merge real-time data with preoperative models seamlessly.

STANDARDIZATION OF 3DVMS AND LIMITATIONS
Despite the progress made in this field, many technical and ethical concerns still need to be addressed.

A large part of the urological community is blind regarding the preconditions needed and the correct steps
to produce 3DVMs .
[16]
The widespread of a standardized process is needed for the creation of 3DVMs which can be used by every
surgeon as a certificated medical device. Several 3DVM companies have already gained recognition from
TM
Food and Drug Administration (FDA), along with the ICON3D system, for example, IRIS (Intuitive
Surgical; Sunnyvale, CA), a platform for surgical planning and navigation produces 3DVM following a
specific workflow giving relatively standardized 3DVM. Surgeons can upload on this platform CT scan
images and obtain the correspondent 3DVM in 24-48 h.

However, there is still inconsistency in the quality of the final delivered product due to the wide number
and type of processes and different software packages available. Moreover, 3D modeling requires a trained
team with a significant level of expertise.

Indeed, the risk is to deliver inaccurate 3DVM which could dramatically influence surgical approach or
technique based on inexact information obtained from the model itself.

In an effort to streamline the process, a team of surgeons and engineers has begun developing guidelines for
reporting criteria and workflow steps in research projects focused on producing 3DVMs. The goal is to
review the methodology reporting on three-dimensional modeling (3DM) reconstruction to estimate the
quality of the models used to guide the surgical act (https://www.crd.york.ac.uk/prospero/display_record.
php?ID=CRD42021276893). The review will assess if the reported methodology in each study includes
acquisition of DICOM images, segmentation procedure and software used, post-processing phase
(including smoothing of the triangles), and 3D reconstruction validation and visualization.

Checcucci et al. have already submitted a proposal for 3D model reconstruction guidelines to the
EQUATOR Network website (www.equator-network.org) to equip the scientific community with a new
resource in the near future .
[16]