Robotic partial nephrectomy: Techniques for complex tumors

Robotic assisted partial nephrectomy is an effective and minimally invasive approach that has gained significant popularity in the past 20 years. Guidelines support prioritizing partial nephrectomy in small renal masses when technically feasible, given improvement in long term renal function and cardiovascular risk. Increasing surgeon comfort with the robotic platform has allowed for the removal of larger and more complex tumors. There are a vast number of surgical techniques described in the literature for dissection, hilum clamping, tumor resection and renorrhaphy. We aim to describe and summarize different considerations and techniques to utilize when performing robotic assisted partial nephrectomy in complex renal masses. In this review, we specifically focus on masses with higher tumor complexity (RENAL score ≥10, those that involve or about the hilum or are invasive into the renal sinus).