Researchers at Regina Margherita Children’s Hospital and the University of Turin have reported that 3D virtual reconstruction (3DVR) was rated above computed tomography (CT) and magnetic resonance imaging (MRI) for planning surgery on complex pediatric kidney tumors. The retrospective study covered eight patients under 18 treated between October 2021 and January 2025.

A panel of three oncological surgeons and one radiologist scored both methods on a five-point Likert scale. 3DVR scored higher for depicting the tumor, arteries and veins (p<0.0001 for each), for defining eligibility for nephron-sparing surgery (NSS) (p=0.0003) and for ease of use during surgery (p=0.0006). The urinary collecting system showed no statistically significant difference (p=0.0888).

Medics srl of Turin built the models from MRI and CT data using Materialize’s Mimics Medical and 3-matic Medical software, after which surgeons received interactive 3D PDF files for planning and intraoperative use. The team did not 3D print the models, citing cost and the ability of virtual versions to render structures see-through during surgery.

Three patients underwent robotic NSS, and four had open radical nephrectomy. In the eighth, a child with Beckwith-Wiedemann syndrome, 3DVR indicated NSS was not feasible, and chemotherapy and surveillance continued. In a patient with WAGR syndrome, the models showed pelvic invasion not visible on conventional imaging, which ruled out NSS.

The authors reported 92% agreement between 3DVR tumor volume and histological volume, against 66% for conventional imaging. Resection margins were unaffected in all cases.

The two complications were a grade 1 intraoperative lesion of the upper renal calyces, which was sutured, and a grade 3b postoperative bowel obstruction that required laparotomy.

The authors acknowledged that the small cohort limited the statistical analysis and that the operating surgeons, rather than independent observers, completed the questionnaires, resulting in a call for multicenter prospective studies as part of further research into the subject.