Technologic advances in robot-assisted nephron sparing surgery: a narrative review.

Area of Science:

• Urology
• Surgical Oncology
• Medical Technology

Background:

• Nephron sparing surgery (NSS) is the standard for clinical stage T1 (cT1) renal masses.
• Indications for NSS are expanding to larger and more complex renal tumors.
• The goal of NSS is to achieve the 'pentafecta' of optimal patient outcomes.

Purpose of the Study:

• To provide an overview of recent advances in the pre-, intra-, and post-operative management of renal masses undergoing NSS.
• To highlight technological advancements and technique refinements in NSS.

Main Methods:

• A non-systematic literature search of PubMed and MEDLINE was conducted.
• Articles published between 2010 and 2022 were included.
• Only full-text English articles from peer-reviewed journals were considered.

Main Results:

• Advances include improved imaging (3D reconstruction, color Doppler, contrast-enhanced ultrasound) and novel fluorescence-guided imaging.
• Augmented reality is emerging for education, and new reconstructive techniques/sealing agents show promise.
• Early Recovery After Surgery (ERAS) protocols facilitate earlier discharge without increased complications and reduce costs.

Conclusions:

• NSS management has evolved with pre-operative imaging, intra-operative techniques, and post-operative protocols like ERAS.
• Further prospective studies are needed to validate the impact of novel imaging, in-vivo fluorescence biomarkers, and reconstructive techniques on achieving the NSS pentafecta.