Feasibility of 3D vascular reconstruction for preoperative planning in robotic living donor nephrectomy: a retrospective pilot study

Introduction: Patient safety is crucial in donor nephrectomy. Individualized 3D reconstructions from CT imaging are gaining popularity for improving preoperative planning. This study evaluates whether such models enhance anatomical assessment and surgical preparation in robotic live donor nephrectomy. Methods: This retrospective pilot study included 24 patients who underwent robotic live donor nephrectomy between 2022 and 2025. 3D models were reconstructed by the surgeon using MED EINS software and compared to conventional CT reports regarding vascular anatomy. Results: Of the 24 nephrectomies, 75% were left-sided. No intraoperative complications occurred; minor postoperative complications (Clavien-Dindo I/II) were observed in 16.7% of cases. Donors had a mean age of 52.9 years and a mean BMI of 28.0. Most had a single renal artery (83.3%) and vein (91.7%). The mean operative time was 205 min, and hospital stay averaged 6.4 days. Donors were often parents or partners (each 41.7%). 3D reconstructions showed high concordance with CT reports. In one case, a second artery was missed on the CT report but visible on the 3D model, demonstrating its utility for detecting anatomical variants. Conclusion: 3D reconstructions have the potential to support and refine preoperative planning in robotic donor nephrectomy by enhancing anatomical visualization. However, their clinical benefit should be further validated in prospective studies.