Mini-invasive Surgery

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality, with liver metastases being a critical determinant of survival. The management of colorectal liver metastases (CRLM) has historically been challenging due to the complexity of hepatic resections and the need for precision to ensure patient safety and optimal outcomes. Recently, robotic hepatectomy has emerged as a pivotal evolution in minimally invasive surgery, offering a new tool in the treatment of CRLM. This article aims to share some tips and tricks accumulated by our surgical experience in robotic resections of CRLM that have been instrumental in optimizing both outcomes and safety. We explore the multifaceted approach required for successful robotic surgery. A meticulous preoperative evaluation sets the stage for successful robotic liver surgery, where we tailor anesthesia and patient positioning based on tumor location to complement the robotic platform. During surgery, the selection of specialized instruments along with nuanced parenchymal transection techniques is guided by a number of factors, including the quality of the liver and experience of the surgeon. Incremental progression from less to more complex hepatectomies is made possible by adherence to key principles of minimally invasive liver surgery, thoughtful preparation, and surgical precision. Ultimately, this article will contribute to surgeons’ understanding of these principles and practical elements that can help to improve standards of patient care in the performance of robotic hepatectomies for colorectal metastases.

Aims: Sleeve gastrectomy (SG) is currently the most performed bariatric surgery worldwide. For patients with obesity and symptomatic gastroesophageal reflux disease (GERD), the indication of SG is a matter of concern due to the possibility of worsening or de novo reflux in the postoperative follow-up. A new method, the combination of a 180-degree anterior fundoplication (SLEEVE-DOR) using only one barbed nonabsorbable suture, is proposed to allow the use of SG for this set of patients aiming to minimize the occurrence of de novo GERD. The study aims to evaluate the safety, feasibility and efficacy of SG with SLEEVE-DOR for the therapy of patients with obesity. Methods: The study describes the largest series of SG combined with anterior hemifundoplication. Since June 2018, all patients with indications for bariatric surgery and having proton pump inhibitor (PPI) therapy for symptomatic reflux at least 6 months before surgery were prospectively documented. All operations were performed laparoscopically (45) or with a robotic DaVinci platform (35). Clinical data were collected from our bariatric center database. The primary outcomes included technical success, perioperative complications and mortality, and the resolution of symptomatic gastroesophageal reflux after the SLEEVE-DOR procedure. Results: The procedure was successfully performed for all patients (n = 80). Mean operative time was 60.1 min. All patients started oral fluids one hour after the surgery and were discharged between 1st and 3rd postoperative day. Postoperative complications occurred in three patients, with one leak, one peritonitis due to colonic thermic lesion from adherences, and one postoperative death due to massive pulmonary embolism. Four patients claimed intractable reflux between 3 and 6 months and were later converted to a Roux-en-Y gastric bypass (RYGB). The remaining patients experienced complete resolution of reflux symptoms in the 6-month follow-up. The percentage of excess weight loss (%EWL) was 58.5% on postoperative 12 months. Conclusions: SLEEVE-DOR with one nonabsorbable barbed suture is a safe, effective, and technically simple alternative procedure to allow the performance of SG for morbidly obese patients with preoperative mild symptomatic gastroesophageal reflux, especially for patients with severe obesity as the first step operation.

Aim: Liver resection is performed in patients with benign and malignant liver tumors. Advancements in surgical instruments and improved perioperative management have enabled safe laparoscopic and robotic liver resections. Herein, we aimed to evaluate the patients who underwent minimally invasive liver resection (MISLR) and compare their short-term outcomes with those of patients who underwent open liver resection (OLR), according to surgical complexity. Methods: Data of patients who underwent liver resection at our institution from January 2011 to August 2023 were obtained from a prospectively maintained database. We gradually expanded the indications for MISLR from technically less demanding procedures to intermediate- and high-complexity MISLRs. The procedures were categorized into three grades (low, intermediate, and high) according to the liver resection complexity classification. Results: Of the 1,866 patients who underwent liver resection, 953 were included in the analysis. Of the 953 patients, 781 underwent OLR and 172 underwent MISLR. The operative time and estimated blood loss increased with the increase in surgical complexity in the MISLR group, which was similar to finding in the OLR group. The complication rate also increased with the increase in surgical complexity in the OLR group (low complexity vs. high complexity, 34.8% vs. 50.1%). However, the complication rate was steadily low and approximately 10% across all complexity grades in the MISLR group. Conclusion: Careful selection and gradual expansion of the indications of MISLR may facilitate improved postoperative outcomes in patients undergoing highly complex MISLRs.

Currently, there is no established consensus on the best treatment approach for patients with bilateral synchronous renal masses (BSRM). The timing and method of managing these cases remain subjects of debate. This review aims to summarize the available literature and explore the ongoing controversies surrounding this topic. Three studies investigated non-surgical treatments within BSRM. Specifically, one study focused on active surveillance (AS) and showed no statistical differences in terms of progression and development of metastatic disease relative to their unilateral counterpart. Two studies investigated ablative techniques showing promising results. Eight papers have been published regarding robot assisted partial nephrectomy (RAPN) for BSRM. All these papers highlighted the safety, feasibility, and efficacy of bilateral RAPN for BSRM. Literature regarding treatments other than surgery such as AS and ablative therapies (ATs) for BSRM is scarce, but promising. Progression, rate of metastases and survival of BSRM are similar to unilateral disease, and AS is a safe option in these cases. Few studies focused on RAPN related outcomes for BSRMs, but all confirmed the safety, feasibility, and efficacy of this procedure. Finally, one step RAPN resulted as feasible as the two staged procedures, especially when selective clamping techniques can be chosen.

Originating from the olfactory neuroepithelium, olfactory neuroblastoma is a rare malignant tumor of the nasal cavity that typically affects adults between the ages of 35 and 70. Clinical presentation predominantly consists of nonspecific symptoms such as nasal obstruction, nasal drainage or epistaxis, thus illustrating the need for a thorough diagnostic workup. In addition to a complete head and neck examination, rigid nasal endoscopy, biopsy and imaging are necessary to establish a definitive diagnosis as well as plan for treatment. Computed tomography (CT) and magnetic resonance imaging (MRI) are the primary imaging modalities utilized to assess for bony invasion and soft tissue involvement, respectively. Hyams grading system provides a histologic assessment of disease severity while various staging systems correlate severity of disease to anatomic location/progression. Treatment relies on both surgical intervention and radiation. In addition, ongoing research trials are investigating therapeutic targets. Given the risk of recurrence, extended post-treatment surveillance remains necessary.

Nasopharyngeal carcinoma (NPC) is a relatively rare cancer, primarily prevalent in China and other parts of Asia. Radiotherapy is the preferred treatment for primary NPC and has proven to be highly effective. However, approximately 10% of patients experience recurrence after treatment. Surgical intervention serves as a key treatment option for locally recurrent NPC and selected primary cases, aiming to completely remove the tumor while preserving normal tissues and functions as much as possible. This review provides a comprehensive overview of surgical treatment options for NPC discussing the advantages, disadvantages, appropriate indications, and outcomes of various surgical techniques, thus offering guidance for selecting the most suitable treatment approaches.

Capsule endoscopy (CE) is widely employed in clinical practice owing to its minimally invasive nature and high diagnostic accuracy. It is the primary modality for evaluating suspected diseases of the small-bowel, as recommended by guidelines from various countries. Advancements in CE technology have introduced various models for evaluating not only the small-bowel but also the colon, esophagus, stomach, and the entire gastrointestinal tract. Moreover, colon CE enables early detection of colorectal polyps and cancers, as well as surveillance of inflammatory bowel disease. Furthermore, innovative developments, such as magnetically controlled CE, offer enhanced maneuverability, particularly in the stomach. Recent reports highlight the growing use of artificial intelligence in CE, with promising potential for reducing physician burden, and clinical implementation is anticipated. Furthermore, novel CE technologies are expected to enable the diagnosis of gastrointestinal diseases through a less invasive approach in the near future. Key questions/aims: Herewith we provide a comprehensive review of the current status and clinical applications of CE while addressing the challenges that remain in its implementation in practice and highlighting the key areas for future research and development.

The present study aims to provide a contemporary overview of the use of augmented reality (AR) in robotic renal surgery from the renal pedicle management to the demolition and reconstructive phases thanks also to the preoperative planning obtained with three-dimensional virtual models (3DVMs). Recently, the increasing use of the robotic approach extends the indication to partial nephrectomy also in cases of complex or large renal masses and maximizing functional and surgical outcomes. With this goal, new imaging technologies have increased in popularity, especially for laparoscopic and robotic approaches. In this scenario, hyper-accuracy 3DVMs of the kidney and tumor, based on computed tomography (CT) scans, have been developed as a new tool for preoperative planning and intraoperative surgical navigation via AR technology. However, a standardized production process of 3DVMs and dedicated guidelines on their use and application are still needed. A recent systematic review and metanalysis has shed light on the impact of 3D models on minimally-invasive nephron-sparing surgery (NSS). Specifically, lower rates of global ischemia and collecting system violation were observed within AR-robot-assisted partial nephrectomy (RAPN). However, these rates did not translate into significant improvements in terms of oncological or functional outcomes. 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.

The management of small renal masses has evolved over the past several years. Partial nephrectomy is now thought of as the standard of care for the management of small renal masses. Bleeding and calyceal injuries can be challenging to manage and make the procedure technically challenging. The debate between renorrhaphy techniques during robot-assisted partial nephrectomy represents a subject of ongoing discourse. We aim to compare the perioperative and functional outcomes of different renorrhaphy during robot-assisted partial nephrectomy. Our study suggests that different renorrhaphy techniques demonstrated comparable perioperative and functional outcomes in terms of renal function.

Aim: Endoscopic bariatric and metabolic therapies (EBMTs) offer minimally invasive approaches for obesity management, with intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG) being amongst the most prominent interventions. While both are effective, their comparative impact on post-procedural gastric symptoms remains underexplored. Methods: Single-center retrospective study was designed to evaluate the incidence of post-procedure symptoms in patients undergoing IGB and ESG. Incidence and severity of gastric symptoms were assessed using visual analog scales at various time points. Weight outcomes and medication usage were also recorded. Changes at different time points (baseline, one and four months) were compared by means of Mann-Whitney U Test. Bivariate correlations were carried out through Pearson correlation. Results: Thirty patients undergoing IGB placement and 13 patients undergoing ESG were included in the analysis. ESG group showed a significant reduction in BMI at four months compared to IGB (32.2 ± 4.2 vs . 34.4 ± 5.3, P = 0.05). ESG demonstrated significantly lower rates of post-procedural gastric symptoms compared to IGB, including nausea, regurgitation, vomiting, and abdominal cramps and greater satiety (P < 0.001) in the early postoperative period. Medication usage differed between groups, with higher usage of antispasmodics and antiemetics among IGB patients during the first week (P < 0.001). Symptom severity correlated with the need for antiemetics and antispasmodics. Conclusion: This study provides insights into the management of gastric symptoms following two prominent EBMTs. While both endoscopic interventions offer viable options for obesity management, ESG emerges as a favorable choice due to its significantly lower incidence of early post-procedural gastric symptoms. Further research is warranted to refine symptom management strategies and elucidate differences in symptom profiles between IGB and ESG procedures, ultimately aiming to optimize treatment efficacy and patient satisfaction in the field of endoscopic obesity interventions.

Bilateral truncal vagotomies are intrinsic to nearly all esophagectomies, rendering patients susceptible to delayed gastric emptying. The question of whether, how, and when to perform pyloric drainage is essential and remains controversial in the era of robotic-assisted minimally invasive esophagectomy. While a variety of pyloric intervention techniques have been described, selective endoscopic pyloromyotomy for post-esophagectomy patients with durable signs of delayed gastric emptying is an attractive option, given its low morbidity rate, particularly its low incidence of dumping.

The minimally invasive approach has gained popularity in the last decades, even in complex abdominal surgery such as pancreatic resections. Currently, many meta-analyses focus on the benefits and advantages of the minimally invasive approach compared to open surgery, especially during left pancreatectomy (LP). Limited data on the oncological outcomes are available. The review aims to describe the surgical and oncological outcomes of the minimally invasive left pancreatectomy (MILP). The search terms were based on the final histological pathology (pancreatic adenocarcinoma) and the comparison of different surgical approaches (open vs. minimally invasive). The search strategy was constructed in PubMed and adapted to run across other database platforms, focusing on studies published until 2022. A total of 2,878 studies were selected and duplicates were removed. After title and abstract screening, 109 articles remained for full-text assessment, of which 28 met the eligibility criteria for this systematic review. Considering the study design, the studies were divided into retrospective (n = 15), prospective (n = 4), and 13 propensity score-matched (n = 9). The present review of the literature suggests that MILP is technically feasible and safe for treating body and tail pancreatic ductal adenocarcinoma (PDAC). MILP did not have any impact on the major complications, reducing hospitalization. Regarding the oncological outcomes, the surgical technique did not have an impact on the R0 resection rate, lymph node harvested rate, use of adjuvant chemotherapy, and overall survival. Further prospective randomized trials remain indicated to assess the oncological impact of the MILP in patients with PDAC.

The esophagectomy, first done over a century ago, has evolved from open procedures to minimally invasive techniques. As minimally invasive surgery has progressed in both safety and efficiency since its inception, it is becoming increasingly favored and continues to demonstrate advantageous outcomes over open techniques. In terms of operative decisions, conduit diameter choice is crucial in esophagectomy. Narrower conduits (≤ 3 cm) seem to be more efficacious, and less prone to stricture than their wider counterparts (> 5 cm). Perfusion assessment, notably with indocyanine green (ICG), is still a topic of debate among surgeons with conflicting opinions on ICG’s impact. There are varying results in leak rates; however, the use of ICG in determining anastomotic site seems to exert some influence on surgical decision-making. Anastomotic techniques, such as circular stapling and linear stapling, have shown to be preferred over more traditional hand-sewn methods. At our institution, a completely robotic approach is used with creation of a 3-4 cm wide conduit and hybrid-type anastomosis. ICG is used to guide conduit transection and gastrotomy for anastomosis. Our experience shows that this approach offers an excellent combination of safety and reproducibility.

Aim: The growth in the incidence of small renal masses has led the implementation of laparoscopic partial nephrectomy to become the technique of choice. However, arterial clamping and secondary renal ischemia still mean a controversial issue due to the risk of renal failure. Our objective is to evaluate the existing literature and its relationship to our experience. Methods: We performed a retrospective study of our series over six years. We analyzed different clinical, perioperative and postoperative functional outcome variables and compared the relationship between tumor complexity and the need for ischemia as well as the relation between ischemia time and renal function over a follow-up time of 6 months. For the discussion, we led a review of the literature on the subject and the paradigm shift that has taken place over the years. Results: A total of 148 patients, most of them male (68.2%) with an average age of 62.4 [standard deviation (SD) 1.7] years, had a Charlson index of 3 [interquartile range (IQR) 1-4]. The average R.E.N.A.L. score was 6 (IQR 5-8). Intraoperative complications were observed in 8.1% of the cases, most of which involved bleeding from a major artery or vein (7.4%). Postoperative complications occurred in 23.6% of the patients, the majority being classified as Clavien 2. Arterial clamping was carried out in 52.7% of the interventions, with a median ischemia time of 8 min (IQR 0-18). The average hospital stay was three days (IQR 2-5). Previous median glomerular filtration rate (GFR) was 83 mL/min/1.73 m2 (IQR 66.2-93.6). On the first postoperative day, the median GFR was 78.4 (SD 21.8), and at 6 months, it was 75.2 (SD 22). We found no statistically significant differences between having hypertension or diabetes mellitus and GFR after surgery, but we found differences in the correlation of a Charlson index ≥ 3 and deterioration of renal function, being the P values 0.01, 0.08 and 0.00 for the first postoperative day, after three and 6 months, respectively. No statistically significant differences were found in whether having a previous chronic kidney disease influenced the decision to perform arterial clamping or not, with a P value of 0.104. Statistically significant differences were found in the relationship between R.E.N.A.L. score and ischemia time. Conclusion: Renal tumors with a higher R.E.N.A.L. score involve the need to accomplish a longer arterial clamping, but its relationship with the deterioration of renal function is unclear, since there are other risk factors, such as patient’s comorbidities.

The most practical approach for dissecting the liver parenchyma involves first visualizing and subsequently addressing the blood vessels within the parenchyma while maintaining a dry operative field. This process is similar to “excavation” of ancient artifacts from soil without causing any damage. To excavate the blood vessels in a dry operative field during liver parenchymal dissection, proficiency in both blood flow control and parenchymal dissection techniques is mandatory. For blood flow management, inflow control is achieved using an externally applied Pringle maneuver, whereas outflow control is achieved by decreasing the central venous pressure. Precision in parenchymal dissection lies in dissecting the liver parenchyma in areas devoid of the Glissonean branch, such as the intersegmental plane, using the back-scoring technique with a cavitron ultrasonic surgical aspirator (CUSA) to read the grain of the blood vessels.

Over the past few decades, an increasing proportion of abdominal surgeries are performed through minimally invasive platforms. In contrast, adaptation of minimally invasive techniques for liver surgery has garnered slower attraction due to the complexity and associated morbidity and mortality with these operations. Compared to laparoscopy, the robotic-assisted surgical system provides a three-dimensional operative view and instruments with articulation that mimic and extend wrist movement. These elements improve operative dexterity making dissection and suturing easier. Additionally, robotic surgery improves operative ergonomics and decreases physical and mental fatigue. Studies show that the robotic platform is safe and versatile with many technical advantages for complex operations, improved short-term outcomes compared to open surgery, and comparable oncologic outcomes. As such, hepatobiliary surgeons are increasingly adapting robotic techniques in their practice. It is crucial that as more hospitals adopt this technology, patient safety monitoring and quality initiatives are maintained. Establishing a robotic liver surgery program revolves around three pillars: designing a curriculum to overcome the learning curve, building a strong clinical and administrative team, and appropriate patient selection.

In complex oncological liver resections, insufficient future liver remnant (FLR) volume may become the most challenging problem to deal with in the postoperative setting. The Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is one of the techniques described for inducing hepatic hypertrophy and achieving an adequate FLR. The technique initially described is performed by a complete bipartition of the liver in the first operation and a portal vein ligation to achieve occlusion of the intrahepatic circulation followed by a major hepatectomy in the second operation once an adequate FLR has been reached. With the introduction of minimally invasive liver surgery, these procedures can be performed by laparoscopic or robotic approach. We aim to provide a comprehensive overview of ALPPS, highlighting key technical aspects. Furthermore, the main aspects of this technique based on current evidence, such as indications, outcomes, strengths, limitations and potential complications, will be analyzed.

Aim: This study aimed to report the perioperative outcomes of off-clamp robot-assisted partial nephrectomy (RAPN) for multiple ipsilateral renal tumours at our Institution. Methods: Data of consecutive patients affected by multiple ipsilateral renal tumours managed by RAPN between September 2018 and June 2023 were retrospectively analysed. Perioperative and post-operative data were collected. Eventual intra- and post-operative complications with or without readmissions (occurred within 30 days) were recorded and classified according to Clavien-Dindo system. Final pathology examination of excised tumours was performed. Results: Twelve patients were included in the analysis. Median tumour size was 34 mm and median R.E.N.A.L. [(R)adius (tumour size as maximal diameter), (E)xophytic/endophytic properties of the tumour, (N)earness of tumour deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line] score was 6. Median console time was 134 min. An off-clamp approach with pure enucleation was possible in 20 out of 28 lesions (71.4%). Median estimated blood loss was 200 mL. No differences were observed in renal function both at discharge and after 30 days, with respect to baseline. No intraoperative complications were recorded. Post-operative complications occurred in two patients, both classified as Clavien-Dindo grade 2. Positive surgical margins were reported in one case (4.5%). No local recurrence or metastasis were diagnosed within a median follow-up of six months. Conclusion: Our case series showed the feasibility of off-clamp RAPN in patients with multiple ipsilateral renal tumours in experienced hands. Further studies with larger sample size and longer follow-up are warranted to better define the optimal management strategy in such an uncommon scenario.

Robot-assisted minimally invasive esophagectomy (RAMIE) has recently been developed and is increasingly performed for thoracic esophageal and esophagogastric junction (EGJ) cancers. At our institute, we performed RAMIE in the semi-prone position using the da Vinci Xi system with two- or three-field lymphadenectomy in 91 patients with resectable thoracic esophageal or EGJ cancers between October 2018 and March 2023. During this period, we improved and standardized the surgical procedures to perform precise and safe mediastinal lymphadenectomies and minimize postoperative complications. The rates of major operative morbidities (C-D grade, ≥ I) were acceptable (recurrent laryngeal nerve paralysis, 6.6%; pneumonia, 9.9%; atelectasis, 6.7%; anastomotic leak, 14.3%). Both operative and 30-day mortality rates were 0%. In this technical note, we present our standardized surgical techniques for RAMIE in the semi-prone position for esophageal and EGJ cancers.

Aim: To identify the incidence and evaluate predictors of positive surgical margins (PSMs) after robot-assisted partial nephrectomy (RAPN) in patients with clinical T1 renal cell carcinoma (RCC). Methods: After securing ethics committee approval, we analyzed our institution’s prospectively maintained RCC database. Our cohort included 1611 patients who underwent RAPN between January 2017 and December 2022. Surgical specimens were evaluated using standard practices, and the International Society of Urological Pathology (ISUP) grading system was employed. Results: The majority (69.5%) of the 1,611 patients were males. Median age and Body Mass Index were 62.6 years and 26.9 kg/m2, respectively. Overall, 18.6% and 21.1% of the patients had an Eastern Cooperative Oncology Group (ECOG) score ≥ 1 and American Society of Anesthesiologists physical status (ASA PS) score ≥ 3, respectively. Surgical indications were elective in 90.5% of cases. The preoperative aspects and dimensions used for an anatomical (PADUA) score median was 8.0 (interquartile range: 7.0-9.5). The predominant histotype was clear cell RCC, accounting for 70.4% of the cohort. PSMs were detected in 6.7% of the patients. Multivariable logistic regression showed surgical indications with an odds ratio (OR) of 6.06 (P < 0.001), surface, intermediate, base (SIB) score > 1 with an OR of 2.37 (P = 0.001), and PADUA score with an OR of 1.10 (P = 0.006) were significant predictors of PSMs. Conclusion: Attaining negative margins remains the oncological cornerstone of partial nephrectomy. Our data underscore that tumor-specific (PADUA score) and surgical parameters (imperative indication, SIB score > 1, off-clamp approach) are the principal determinants for PSMs after RAPN.

Aim: To identify the incidence and evaluate predictors of positive surgical margins (PSMs) after robot-assisted partial nephrectomy (RAPN) in patients with clinical T1 renal cell carcinoma (RCC). Methods: After securing ethics committee approval, we analyzed our institution’s prospectively maintained RCC database. Our cohort included 1611 patients who underwent RAPN between January 2017 and December 2022. Surgical specimens were evaluated using standard practices, and the International Society of Urological Pathology (ISUP) grading system was employed. Results: The majority (69.5%) of the 1,611 patients were males. Median age and Body Mass Index were 62.6 years and 26.9 kg/m², respectively. Overall, 18.6% and 21.1% of the patients had an Eastern Cooperative Oncology Group (ECOG) score ≥ 1 and American Society of Anesthesiologists physical status (ASA PS) score ≥ 3, respectively. Surgical indications were elective in 90.5% of cases. The preoperative aspects and dimensions used for an anatomical (PADUA) score median was 8.0 (interquartile range: 7.0-9.5). The predominant histotype was clear cell RCC, accounting for 70.4% of the cohort. PSMs were detected in 6.7% of the patients. Multivariable logistic regression showed surgical indications with an odds ratio (OR) of 6.06 (P < 0.001), surface, intermediate, base (SIB) score > 1 with an OR of 2.37 (P = 0.001), and PADUA score with an OR of 1.10 (P = 0.006) were significant predictors of PSMs. Conclusion: Attaining negative margins remains the oncological cornerstone of partial nephrectomy. Our data underscore that tumor-specific (PADUA score) and surgical parameters (imperative indication, SIB score > 1, off-clamp approach) are the principal determinants for PSMs after RAPN.

Partial nephrectomy, a standard treatment for small renal cancers, has evolved through minimally invasive procedures such as laparoscopic and robot-assisted partial nephrectomy. The use of three-dimensional (3D) kidney models derived from preoperative computed tomography (CT) images has been investigated to improve surgical outcomes. This review explores various navigation techniques, such as 3D printing, virtual reality (VR), and augmented reality (AR), to address organ movement and deformation challenges during surgery. Despite the promising positive impact of these methods, as revealed by a systematic review in 2022, achieving the desired navigation accuracy remains elusive. The use of Virtual Reality and Augmented Reality, capable of overlaying the 3D model onto the surgical image in real-time, has shown potential. Still, we need advanced techniques, for instance, non-rigid 3D models employing nonlinear parametric deformation, to adapt to organ deformation. Additionally, the application of deep learning from artificial intelligence for high accuracy 3D navigation is an emerging area of interest. Although considerable progress has been achieved, a comprehensive, widely adoptable solution has yet to be discovered. The paper underscores the necessity for ongoing research and development in 3D navigation methods, anticipating their substantial contribution to future surgical procedures.

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.