Augmented reality: the smart way to guide robotic urologic surgery

The development of a tailored, patient-specific medical and surgical approach is becoming the object of intense research. In robotic urologic surgery, where a clear understanding of case-specific surgical anatomy is considered a key point to optimizing the perioperative outcomes, such philosophy has gained increasing importance. Recently, significant advances in three-dimensional (3D) virtual modeling technologies have fueled the interest in their application in the field of robotic minimally invasive surgery for kidney and prostate tumors. The aim of the review is to provide a synthesis of current applications of 3D virtual models for robot-assisted radical prostatectomy and partial nephrectomy. Medline, PubMed, the Cochrane Database, and Embase were screened for literature regarding the use of 3D augmented reality (AR) during robot-assisted radical prostatectomy and partial nephrectomy. The use of 3D AR models for intraoperative surgical navigation has been tested in prostate and kidney surgery. Its application during robot-assisted radical prostatectomy has been reported by different groups as influencing the positive surgical margins rate and guiding selective bundle biopsy. In robot-assisted partial nephrectomy, AR guidance improves surgical strategy, leading to higher selective clamping, less healthy parenchyma loss, and better postoperative kidney function. In conclusion, the available literature suggests a potentially crucial role of 3D AR technology in improving perioperative results of robot-assisted urological procedures. In the future, artificial intelligence may represent the key to further improving this promising technology.