Surgeons Turn Children’s Kidney Tumors Into 3D Virtual Models Before Operating

Operating on a child’s cancerous kidney is one of the most delicate challenges in pediatric surgery. The tumor is often intertwined with arteries, veins, and the urinary collecting system in a body barely larger than a adult’s forearm, and every millimeter of healthy tissue that can be preserved matters for a lifetime of renal function. A new study from a team at Regina Margherita Children’s Hospital in Turin, Italy, suggests that a technology many people associate with gaming and gadget prototyping — three-dimensional virtual reconstruction — can give surgeons a decisive edge when they plan these operations. The research, published in the journal 3D Printing in Medicine, reports that interactive 3D models built from routine hospital scans were judged clearly superior to conventional two-dimensional imaging for visualizing nearly every anatomical structure that matters during kidney tumor surgery in children.

The clinical problem the Italian team set out to address is well known to anyone who works in pediatric oncology. When a child is diagnosed with a malignant renal mass, the surgical team must decide whether to remove the entire kidney, a procedure called radical nephrectomy, or to attempt nephron-sparing surgery, in which only the tumor and a thin margin of healthy tissue are excised. Nephron-sparing surgery is strongly preferred whenever it is safe, because children who keep functioning kidney tissue face a lower lifetime risk of chronic kidney disease, hypertension, and the long-term consequences of reduced renal reserve. But deciding whether the tumor can be safely shaved away from vital vessels and collecting structures requires an exquisitely detailed understanding of each patient’s unique anatomy — something that flat CT and MRI slices, read one at a time, do not always convey intuitively even to experienced surgeons.

The Turin group, led by pediatric urological surgeon Elisa Cerchia together with colleagues from the hospital’s pediatric surgery, oncology, and radiology units and the urology department of the University of Torino, tested a straightforward technical workflow. Standard abdominal MRI or CT examinations were performed for each patient as part of normal clinical care. The image data, stored in the universal DICOM format that medical scanners produce, were then imported into segmentation software. Segmentation is the computational process of outlining, slice by slice, the boundaries of each structure of interest — the tumor, the renal artery and its branches, the renal vein, the healthy kidney parenchyma, and the urinary collecting system. Once each structure is traced, the software renders it as a colored, fully rotatable three-dimensional object that can be zoomed, turned, made translucent, or viewed from any angle on a screen, effectively letting the surgeon fly through the child’s anatomy before making a single incision.

Eight patients, four boys and four girls, with complex renal masses were included in the study. For each child, the 3D virtual reconstruction was completed before surgery and reviewed by the surgeons and the pediatric radiologist involved in the case. To evaluate the technology rigorously rather than anecdotally, the team designed a modified closed-ended questionnaire administered in two phases, one before the operation and one afterward. Respondents compared the 3D models directly against the conventional imaging studies, rating how well each modality displayed the tumor and its relationships with arteries, veins, and the urinary tract, and assessing whether the reconstruction helped define the criteria for choosing nephron-sparing surgery over radical removal. The questionnaire also asked whether the models were practical to consult during the operation itself.

The statistical results were striking. For the tumor, the arteries, and the veins, the 3D virtual reconstructions were rated significantly better than conventional imaging, with p-values below 0.0001 for each of those structures — a level of significance that indicates the difference is extremely unlikely to be a statistical fluke even in a small case series. The urinary tract was the one exception; here the advantage of the 3D models did not reach statistical significance, with a p-value of 0.0888, suggesting that the collecting system may already be adequately visualized by standard scans or that segmentation of this thin-walled structure is technically harder to render convincingly. Even so, the overall pattern was unmistakable: the interactive models outperformed the flat images that surgeons have relied on for decades.

Perhaps the most clinically meaningful finding concerned surgical decision making. The study found that 3D virtual reconstruction was significantly more effective in defining the elective criteria for nephron-sparing surgery, with a p-value of 0.0003. In practical terms, this means the models helped surgeons judge whether a tumor could be removed while preserving healthy kidney tissue — the single most consequential decision in these operations. The questionnaire results also showed that the models were fundamentally easier to use during surgery than conventional images, with a p-value of 0.0006. A surgeon in the operating room can glance at a rotatable 3D model and instantly re-orient themselves in three-dimensional space, whereas scrolling through stacks of two-dimensional slices mid-operation is cumbersome and mentally taxing.

In the series, the eight children underwent a total of seven recorded operations: four radical nephrectomies and three nephron-sparing procedures. That three of the children could be treated with kidney-preserving surgery at all reflects the kind of complex, carefully selected cases for which preoperative three-dimensional planning is most valuable. In tumors judged too large or too centrally located for partial removal, the models still contributed by clarifying vascular anatomy before a radical nephrectomy, where precise knowledge of the renal artery and vein is essential for safe vessel control. The authors conclude that 3D virtual reconstruction is a genuinely useful tool in the preoperative evaluation of children with complex renal masses and that it facilitates nephron-sparing surgery in selected patients.

The technical pipeline behind these results deserves attention because it is reproducible in any hospital with standard imaging equipment. No additional scanning is required; the same DICOM datasets acquired for diagnosis feed the reconstruction. Segmentation software separates the anatomy into labeled structures, and rendering engines assemble them into interactive volumes. Some centers in the broader field go further and 3D-print physical models from the same data, which can be sterilized and brought into the operating theater, but the Turin study focused on the virtual models themselves, which require no printing hardware and can be shared instantly across the surgical team, from the operating room to the tumor board where treatment decisions are made.

What makes the study especially credible is its multidisciplinary design. The questionnaire was completed not only by the operating surgeons but also by the pediatric radiologist responsible for interpreting the original scans, meaning the comparison between 3D and conventional imaging was evaluated from multiple professional perspectives. The work also drew on collaboration with adult urological surgeons at the Città della Salute e della Scienza hospital in Turin, bringing experience from the larger field of kidney surgery into the pediatric arena. The project received no external funding, and the authors declare no competing interests, with technical support for the reconstruction workflow acknowledged from a collaborating company. The study was approved by the local ethics committee, and informed consent was obtained from each child’s parents or guardian in accordance with hospital rules.

Caveats remain, as they do with any small, single-center case series. Eight patients cannot establish how often 3D planning changes the final operative decision, whether it shortens operative times, reduces complications, or improves long-term kidney function — outcomes that will require larger, ideally multi-center comparative studies. The near-significant result for the urinary tract hints that some structures remain harder to model than others. Still, the consistency and strength of the reported significance levels, particularly for tumors and blood vessels, give the findings real weight. For a specialty in which the stakes are measured in decades of renal health for young patients, the message from Turin is compelling: letting surgeons rehearse a child’s cancer in three dimensions before entering the operating room is no longer a futuristic gimmick but a practical, statistically validated planning tool that may help more children keep the kidney tissue they will need for the rest of their lives.

Subject of Research: Use of 3D virtual reconstruction from MRI and CT scans for preoperative planning of oncologic renal surgery in children

Article Title: 3D virtual reconstruction: usefulness in preoperative planning for oncologic renal surgery in children

Article References: Cerchia, E., Ruggiero, E., Teruzzi, E., Serpentino, M., Cirigliano, L., Quarello, P., Petraz, M., Catti, M., Allasia, M., Gontero, P., Fagioli, F., & Nappo, S. G. (2026). 3D virtual reconstruction: usefulness in preoperative planning for oncologic renal surgery in children. 3D Printing in Medicine. https://doi.org/10.1186/s41205-026-00340-y

Image Credits: AI Generated

DOI: 10.1186/s41205-026-00340-y

Keywords: 3D virtual reconstruction, pediatric surgery, renal tumors, nephron-sparing surgery, surgical planning, 3D Printing in Medicine, DICOM segmentation, pediatric oncology, kidney cancer, preoperative imaging, MRI, CT