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Page 10 of 12 Pecoraro et al. Mini-invasive Surg 2024;8:25 https://dx.doi.org/10.20517/2574-1225.2023.134

Concerning the most appealing 3DVM-derived surgical navigation systems, two major barriers still hinder
their diffusion and implementation. First, current AR technologies lack the ability to adequately simulate
elastic deformation of the model, and artifacts related to movement, such as breathing, require further
refinement.

This necessitates ongoing and meticulous assistance from an expert urologist or engineer to manually adjust
the alignment of the 3D model with the anatomy in real time during RAPN, with a 0.5-second delay
through the TilePro window.

Secondly, the occlusion of robotic instruments by the 3DVM during surgery remains a concern. Not all
instruments may be clearly visible in AR, as the superimposition of a 3D model can obscure parts of the
surgical field, including the instruments, potentially creating a hazardous situation.

To address these issues, De Backer et al. proposed an algorithm leveraging deep learning networks to detect
all non-anatomical items during AR-guided robot-assisted kidney transplantation . In this context,
[39]
artificial intelligence and deep learning algorithms could help resolve localization challenges by recognizing
robotic instruments that may be obscured by the superimposed 3D model . Additionally, numerical
[40]
methods could assist in generating realistic model deformation sequences to account for motion artifacts or
surgical manipulation.

In the near future, 3D models are expected to achieve automatic alignment with maximal accuracy and
minimal delay. However, the cost of this technology remains a significant barrier to its widespread adoption
in routine clinical practice .
[17]
CONCLUSION
This review provides a contemporary overview of the use of AR in robotic renal surgery from the renal
pedicle management to the demolition and reconstructive phases thanks also to the preoperative planning
obtained with 3DVMs.

Literature demonstrated that 3DVMs are an ally for surgeons in the form of a medical device to perform
virtual tailored surgery before the operating room, with the aim of minimizing risks and complications.

However, specific guidelines and a standardization of 3DVM production process are needed in order to
offer the best and accurate help for surgeons even in more challenging and complex cases.

DECLARATIONS
Authors’ contributions
Literature research, writing and editing: Pecoraro A, Piramide F, Amparore D

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.