Validation of an intraoperative augmented reality (3d-AR) system for Sutureless robot assisted tumor enucleation of localized renal masses: a prospective single- center on 20 patients

Robot-assisted tumor enucleation (RATE) is a nephron-sparing approach for localized renal tumors. However, cortical renorrhaphy and diffuse “blanket” cauterization of the resection bed can compress or thermally injure healthy parenchyma, potentially affecting postoperative renal function. We prospectively evaluated an intraoperative three-dimensional augmented reality (3D-AR) system developed by the DIMES Bioengineering Laboratory (University of Bologna) to guide a sutureless RATE workflow. Twenty consecutive patients underwent AR-guided enucleation with targeted, point-by-point coagulation of the main vessel facing the resection bed, avoiding routine renorrhaphy. Primary endpoints were feasibility of AR guidance and intraoperative need for renorrhaphy; secondary endpoints included operative time, clamping/ischemia, complications, and renal function changes. AR guidance facilitated accurate identification of the anatomical plane and main bleeding vessel, enabling selective hemostasis while preserving healthy parenchyma. No major complications or acute kidney injury were observed; renal function was preserved at short-term follow-up.