Abstract

Background: The widespread use of CT imaging has increased the detection of incidental renal masses. Partial nephrectomy is technically demanding, particularly in anatomically complex tumors, where spatial understanding is essential. Three-dimensional (3D) reconstruction and immersive visualization may support anatomical interpretation, but commercial platforms can be expensive. Objective: To describe a low-cost workflow for renal 3D reconstruction from contrastenhanced CT scans and immersive visualization using an affordable virtual reality (VR) headset, and to report its preliminary clinical application. Methods: This initial technical report describes a preliminary experience in three consecutive patients undergoing partial nephrectomy for localized renal cancer, without a comparator group. Contrast-enhanced CT scans were segmented using 3D Slicer®, and the models were viewed with an Oculus Quest 2® headset. Three urologists reviewed the models preoperatively and, after surgery, assessed subjective perceived spatial understanding, intraoperative orientation and usefulness for surgical planning through an ad hoc questionnaire. Results: Models depicting renal anatomy and tumor location were generated for all three cases; objective geometric accuracy was not assessed. Median operative time was 100 minutes, median estimated blood loss was 90 mL, and hospital stay ranged from 1 to 2 days. Two of the three urologists (2/3) reported improved depth perception and spatial understanding compared with conventional CT, and perceived that the model allowed personal better orientation during surgery and considered it helpful for surgical planning; the third surgeon preferred conventional CT. No specific changes to the operative strategy attributable to the models were documented. Conclusions: Open-source segmentation software and a consumer VR headset permitted immersive visualization of renal 3D models in this initial technical report, and two of three urologists perceived better intraoperative orientation. Larger comparative studies with objective anatomical v

Keywords

three-dimensional imaging virtual reality, renal tumors, partial nephrectomy, computed tomography, surgical planning