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

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic-assisted partial nephrectomy (RAPN) offers technical benefits for complex renal masses.
• Outcome data from new centers performing RAPN are limited.
• Validation of RAPN for complex cases is crucial for broader adoption.

Purpose of the Study:

• To detail the RAPN technique for complex renal tumors.
• To evaluate perioperative outcomes during the initial experience at an emerging center.
• To assess the feasibility and safety of RAPN for challenging kidney cancers.

Main Methods:

• Prospective analysis of 35 consecutive RAPN procedures using a five-port transperitoneal approach.
• Inclusion of complex cases: endophytic, centrally located, or collecting system-proximal tumors.
• Data collection included operative parameters, complications, and functional preservation.

Main Results:

• Mean tumor size 4.01 cm; mean RENAL score 6.4, with 54.3% endophytic.
• Mean operative time 198.5 min, console time 143.0 min, warm ischemia 29.2 min.
• Zero positive margins, minimal creatinine increase (0.13 mg/dL), and 82.9% trifecta achievement.

Conclusions:

• The described RAPN technique yields excellent perioperative outcomes for complex renal masses.
• Reproducible results were achieved during the learning curve at an emerging center.
• RAPN is a safe and effective option for challenging kidney tumors, supporting its use in new institutions.