Abstract:

Objective To evaluate the feasibility and effectiveness of 3D digital holographic imaging combined with intraoperative navigation technology in the context of partial nephrectomy. Methods A total of 46 patients who underwent laparoscopic partial nephrectomy in the Department of Urology at the Second People's Hospital of Hefei City between June 2023 and January 2025 were randomly assigned to either the experimental group or the control group. The experimental group （n = 23） utilized preoperative planning and intraoperative real-time navigation based on 3D digital holographic imaging， whereas the control group （n = 23） relied on preoperative planning using optimized two-dimensional images obtained via contrast-enhanced CT and MRI scans. Preoperative data—including gender， age， body mass index （BMI）， tumor diameter， and RENAL score—were collected. Intraoperative parameters such as total operative time， warm ischemia time， intraoperative blood loss， hemoglobin levels， postoperative hospitalization duration， and time to drain removal were recorded. Renal function changes were assessed by comparing serum creatinine levels and estimated glomerular filtration rates （eGFR） before surgery and one month post-surgery. Additionally， the incidence of intraoperative complications—particularly injury to the renal collecting system—and postoperative complications—including positive surgical margins， bleeding， subcutaneous emphysema， and urinary fistula—was analyzed. Results In this study， holographic images were successfully reconstructed for 23 patients with renal tumors in the experimental group. Each anatomical structure—including the kidney and tumor lesions， collecting system， renal arteries and veins， adrenal glands， and inferior vena cava—was color-coded to enable intuitive visualization. These images were used for preoperative planning and provided real-time spatial orientation to accurately locate and guide resection of the tumor during surgery. In the control group， 23 patients underwent preoperative planning based on contrast-enhanced CT and MRI scans acquired using optimized parameters. All 46 patients underwent laparoscopic partial nephrectomy performed by the same qualified surgeon， and postoperative pathological analysis confirmed renal tumors， including 27 cases of clear cell carcinoma， 7 cases of chromophobe cell carcinoma， 5 cases of papillary cell carcinoma， 2 cases of sarcomatoid carcinoma， and 5 cases of angiomyolipoma. No significant differences were observed in baseline clinical characteristics （including age， body mass index， tumor diameter， and RENAL score） between the two groups （P > 0.05）. The experimental group showed significantly lower values in total operative time， warm ischemia time， intraoperative blood loss， pre- to postoperative hemoglobin changes， and pre-surgical to one-month post-surgical creatinine changes compared to the control group （P < 0.01）. Additionally， the experimental group exhibited smaller changes in hospitalization duration， time to drain removal， and glomerular filtration rate from preoperative to one month post-surgery； however， these differences were not statistically significant （P = 0.175， P = 0.331， and P = 0.273）. There were no intraoperative complications or damage to the collecting system in either the experimental or control groups. Postoperatively， the control group experienced one case of positive surgical margin， one case of hemorrhage， and one case of subcutaneous emphysema. No statistically significant differences were observed between the groups （P > 0.05）. Conclusions 3D digital holographic imaging combined with intraoperative navigation technology， based on the fusion of MRI and CT data， facilitates preoperative planning and precise intraoperative guidance. This approach helps reduce operative time， preserve renal function， and lower perioperative risks while ensuring therapeutic efficacy.

Key words: 3D digital hologram, intraoperative navigation, laparoscopic partial nephrectomy, renal function