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Fasanella. Mini-invasive Surg 2024;8:5 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.79

Review Open Access

Intraoperative imaging techniques for robotic-

assisted partial nephrectomy: where do we stand?

Daniela Fasanella
Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila 67100, Italy.

Correspondence to: Dr. Daniela Fasanella, Department of Life, Health and Environmental Sciences, University of L’Aquila,
piazzale S. Tommasi 1, L’Aquila 67100, Italy. E-mail: danielafasanella20@gmail.com

How to cite this article: Fasanella D. Intraoperative imaging techniques for robotic-assisted partial nephrectomy: where do we
stand? Mini-invasive Surg 2024;8:5. https://dx.doi.org/10.20517/2574-1225.2023.79

Received: 1 Jul 2023 First Decision: 7 Nov 2023 Revised: 27 Feb 2024 Accepted: 18 Mar 2024 Published: 21 Mar 2024

Academic Editors: Giulio Belli, Michele Marchioni Copy Editor: Dong-Li Li Production Editor: Dong-Li Li

Abstract
Robot-assisted partial nephrectomy is currently the gold standard treatment for localized selected cT1 and cT2
renal tumors. This narrative review aims to analyze the technologies employed in this procedure to increase the
precision and accuracy of the surgeon, in order to obtain adequate oncological radicality, negative surgical margins,
and good preservation of renal function. In this scenario, new technologies are developing, from three-dimensional
reconstructions to artificial intelligence up to the new concept of metaverse.

Keywords: Partial nephrectomy, renal cancer, robotic surgery, 3D imaging, augmented reality, artificial intelligence

INTRODUCTION
Partial nephrectomy (PN) has emerged as the standard of care for treating selected cT1 and cT2 renal cell
tumors, with oncological outcomes comparable to radical nephrectomy and maximal preservation of renal
function . Robot-assisted partial nephrectomy (RAPN) has become a widespread nephron-sparing surgery
[1]
(NSS) modality due to its technical advantages and shortened learning curve compared to laparoscopic
partial nephrectomy (LPN) while achieving comparable perioperative outcomes . In performing NSS, the
[2]
urologist aims to achieve the Trifecta, defined by three criteria: negative surgical margins (NSM), a limited
[3]
warm ischemia time (WIT), and the absence of complications . However, sometimes NSS can be
challenging, resulting in a complete resection of the tumor. Marszalek et al. have highlighted a rate of
patients with positive surgical margins (PSM) after NSS ranges from 0% to 7%, and in the case of single or

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