Xin Chang Zou Xiang Da Xu Jian Biao J. Huang Hai Chao Chao Tao Zeng ^*

• Second Affiliated Hospital of Nanchang University, Nanchang, China

Purpose:Robot-assisted laparoscopic partial nephrectomy(RAPN) has become a key technology in the treatment of renal tumors.Effective preoperative planning and precise intraoperative navigation are critical to a successful surgical outcome.This study aimed to evaluate the clinical application value of mixed reality(MR) in robotic nephron-sparing partial nephrectomy for patients with renal tumors of different complexity based on the R.E.N.A.L score. Patients and methods:A retrospective analysis was conducted on 68 eligible patients with renal cancer who underwent robot-assisted laparoscopic partial nephrectomy at the Second Affiliated Hospital of Nanchang University from January 2021 to December 2023,with postoperative pathology confirmation.Patients were divided into two groups: the mixed reality(MR) group,with 28 cases, and the traditional imaging(control) group, with 40 cases.All patients underwent mid-abdominal CT plain scans and enhancements.The MR group utilized three-dimensional reconstruction of CT data and employed 3D Tablets and Hololens glasses for preoperative discussions,surgical planning, and intraoperative guidance.Collect clinical data and metrics to assess surgical outcomes, as well as evaluate performance in areas such as preoperative discussions,doctor-patient communication,surgical planning, and intraoperative navigation. Results: Compared to robot-assisted partial nephrectomy in the control group, the MR group experienced a reduction in operation time by approximately 30 minutes [(135.89±23.494)min vs (165.00±34.320)min, P<0.001)], and a decrease in ischemia time by around 2.5 minutes [(20.36±3.956)min vs (23.80±6.889)min, P=0.02)]. Within the subgroup with a R.E.N.A.L score of less than 7 points, the MR group only showed a significant reduction in operation time [(134.55±150.190)min vs (150.19±28.638)min, P=0.045], with no notable differences in other parameters. For the subgroup with a R.E.N.A.L score of 7 points or higher, the MR group exhibited shorter operation time [(140.83±25.183)min vs (195.77±23.080)min, P<0.001] and reduced warm ischemia time [(21.17±2.714)min vs (28.85±7.570)min, P=0.029]. Additionally, there was less estimated blood loss [(53.33±5.164)min vs (114.62±80.376)min, P=0.018]. All patients had negative resection margins, indicating equivalent therapeutic outcomes between the two groups. Conclusion:In comparison to traditional robot-assisted laparoscopic partial nephrectomy,MR technology demonstrates the ability to decrease operation time and warm ischemia time,all the while maintaining equivalent curative outcomes.Additionally,it enhances preoperative discussions, doctor-patient interactions, preoperative strategizing, and intraoperative navigation, particularly excelling in complex renal tumor cases of RAPN,where its benefits are most pronounced.