Application of three-dimensional reconstruction combined with enhanced recovery after surgery in patients undergoing laparoscopic partial nephrectomy: a prospective observational study.

BACKGROUND: Three-dimensional (3D) reconstruction and enhanced recovery after surgery (ERAS) are increasingly incorporated into minimally invasive nephron-sparing surgery. However, evidence describing their combined perioperative pathway in laparoscopic partial nephrectomy (LPN) remains limited. This study aims to evaluate perioperative outcomes and short-term renal function associated with an integrated 3D reconstruction plus ERAS pathway in patients undergoing LPN. METHODS: In this prospective observational study, 120 patients with localized T1 renal tumors were allocated to either the 3D+ERAS pathway or standard care based on patient preference and resource availability. Perioperative outcomes and renal function were compared between groups. Longitudinal renal function (serum creatinine and eGFR) was assessed using linear mixed-effects models. The primary endpoint was a ≥ 25% decline in eGFR at 3 months. To limit overfitting, a parsimonious multivariable logistic regression model was used; Firth correction and inverse probability of treatment weighting (IPTW) were performed as sensitivity analyses. Ninety-day postoperative outcomes, including hospital readmission and major complications, were analyzed descriptively, rather than using Kaplan-Meier survival analysis for event-free survival. RESULTS: The 3D+ERAS pathway was associated with shorter operative metrics, reduced blood loss, and faster postoperative recovery compared with standard care. A ≥ 25% eGFR decline occurred in 16.7% of the 3D+ERAS group versus 36.7% of controls. Linear mixed-effects models demonstrated significant group × time interactions for both serum creatinine and eGFR, indicating more favorable renal functional trajectories in the combined-pathway group. In the constrained multivariable model, the integrated 3D+ERAS pathway showed a marginal association with lower odds of eGFR decline (adjusted OR 0.37, 95% CI 0.14–1.01, P = 0.051). CONCLUSIONS: In this cohort, an integrated three-dimensional reconstruction plus ERAS perioperative pathway was associated with favorable perioperative recovery patterns and short-term renal functional trajectories in routine clinical practice. However, because the two components were implemented as a bundled strategy and did not vary independently, these findings should be interpreted as descriptive, hypothesis-generating associations rather than evidence of superiority over standard care or of the isolated effects of either intervention. CLINICAL TRIAL NUMBER: Not applicable.