Background: The aim of this paper was to establish a new surgical difficulty scoring system of robot-assisted partial nephrectomy (RAPN) based on three-dimensional (3D) virtual imaging.

Methods: We collected data from the patients subjected to robot-assisted surgery. 296 presented complete demographic and clinical data including RAPN and robot-assisted radical nephrectomy (RARN). Researchers used preoperative enhanced CT or MRI image data, and 3D image reconstruction, 4 independent variables were assessed: diameter of tumor inside kidney (D); compression of the renal segmental vessels; occupation of the renal sinus; mass exophytic rate (DCOM). DCOM score was then used to aid surgical decision-making and guide surgical strategy planning. The predictive values of DCOM score were analyzed using a multinomial logistic regression mode.

Results: We confirmed that DCOM score as predictor of surgical outcome significantly outperformed the other common predictors used (RENAL and PADUA score).

Conclusions: The surgical difficulty scoring system (DCOM scoring system) of partial nephrectomy (PN) based on 3D virtual imaging-based nephrometry system could provide a basis for the formulation of preoperative surgical strategy, but further verification is needed.