**7. Future developments**

We describe a few developing technologies which may be of interest to urologists.

Reconstruction and navigation technology appears to have an emerging role in both preoperative and intraoperative planning and operative assistance. A diverse group of 108 urologists of various training experience changed their views to feel an RAPN over a radical nephrectomy was indicated from 47–75% of the 20 complex cases reviewed following a re-review of the CT scan with three dimensional reconstruction of the renal units [38].

Hyperaccuracy three dimensional (HA3D) is an emerging technology allowing three dimensional reconstructions, enabling virtual mapping of the in-vivo structures with the reconstructed model during the partial nephrectomy. A small sample sized study in complex renal tumours (PADUA >10), using this HA3D technology enabled intraoperative management of the pedicle as preoperatively planned in 90% of the cases [39]. The accuracy of the arterial reconstruction enabled preoperative simulation of vascular ischaemia by selective clamping. This enabled reduction of global ischaemia from 81–24% with the use of the HA3D technology [39].

Near-infrared fluorescence (NIRF) technology using an intravenous contrast medium (e.g. Indocyanine green) enables identification of the segmental vessels perfusing the renal tumour, by switching between white light and fluorescence enhanced views intraoperatively [40]. NIRF RAPN has been found to have a lower loss in renal scan confirmed renal function in the operated unit and a lower reduction in Glomerular Filtration Rate (GFR of 8%)compared to standard RAPN without selective vessel clamping. In three of the 15 NIRF RAPN cases, selective clamping was converted to standard clamping as incomplete ischaemia of the tumour was identified. This demonstrates NIFRs growing benefit over non-NIFR selective clamping.

Urologists participating in a study on 3D (Three Dimensional) printed models of the kidney, favoured its use in preoperative planning, patient counselling and surgical training [41]. The authors report maximal benefit of these models in patients with complex renal vasculature [42].
