Robotic partial nephrectomy for complex renal masses: technical approach and perioperative outcomes

Robotic-assisted partial nephrectomy (RAPN) offers technical advantages for complex renal masses, but outcome validation from emerging centres remain limited. To describe our RAPN technique for complex renal tumours and evaluate perioperative outcomes during initial institutional experience. We performed 35 consecutive RAPN procedures using a five-port transperitoneal approach following STROBE guidelines. Technical steps, operative parameters, and complications were prospectively analysed. Complex cases included endophytic tumours, central locations, and proximity to the collecting system. Mean tumor size was 4.01 ± 0.76 cm with a mean RENAL nephrometry score of 6.4 ± 1.6, and 54.3% demonstrating an endophytic growth pattern. Mean operative time was 198.5 ± 12.5 min with console time 143.0 ± 12.9 min. Warm ischemia time averaged 29.2 ± 4.8 min. Conversion rate was 5.7%. Zero positive margins were achieved with acceptable functional preservation (mean creatinine increase 0.13 mg/dL). Trifecta outcomes were achieved in 82.9% of cases. Our RAPN technique achieves excellent perioperative outcomes for complex renal masses with reproducible results during the learning curve at emerging centres.