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Renal Functional Outcomes in Robot-Assisted Partial Nephrectomy with Minimum Layer Resection Using Virtual

Shuji Isotani1, Tomoki Kimura1, Taiki Ogasa1

  • 1Department of Urology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan.

Journal of Clinical Medicine
|October 29, 2025
PubMed
Summary

Robot-assisted partial nephrectomy (RAPN) using the Minimum Layer Resection (MLR) method preserves kidney function and offers oncological safety for localized kidney cancer. This technique shows good mid-term results, with predictors of kidney function decline identified.

Keywords:
Minimum Layer Resection (MLR) methodrobot-assisted partial nephrectomy (RAPN)three-dimensional virtual partial nephrectomy (3DvPN)

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Robot-assisted partial nephrectomy (RAPN) is standard for localized renal cell carcinoma (RCC), focusing on kidney function preservation.
  • The Minimum Layer Resection (MLR) method, guided by 3D virtual partial nephrectomy (3DvPN) planning, aims to balance oncological safety and parenchymal preservation.
  • This study assesses functional and oncological outcomes of RAPN with MLR and identifies predictors of renal functional decline.

Purpose of the Study:

  • Evaluate functional and oncological outcomes of RAPN utilizing the MLR technique guided by 3DvPN planning.
  • Identify predictors associated with renal functional decline after RAPN with MLR.
  • Assess the efficacy of MLR in balancing oncological safety and parenchymal preservation.

Main Methods:

  • Retrospective analysis of 237 patients undergoing RAPN between 2012 and 2022 with at least 36-month follow-up.
  • 3DvPN planning guided MLR; both MLR and non-MLR techniques were used based on indications.
  • Primary endpoint: estimated glomerular filtration rate (eGFR) preservation at 36 months; secondary endpoints: perioperative outcomes, acute kidney injury (AKI), margin involvement, and recurrence.

Main Results:

  • Median patient age was 60 years, tumor size 29 mm, and warm ischemia time (WIT) 21 minutes; 62.8% achieved selective or superselective clamping.
  • Postoperative AKI occurred in 25.0% of patients; median eGFR preservation at 3 years was 84.4%, with 28.5% experiencing a ≥10% decline.
  • Independent predictors for short-term eGFR decline included BMI > 25 kg/m², AKI, and WIT > 25 min; long-term decline was associated with tumor size > 30 mm and WIT > 25 min. Margin involvement was 1.7%, recurrence 3.8%.

Conclusions:

  • RAPN with MLR under 3DvPN guidance shows favorable perioperative results, acceptable oncological safety, and good mid-term renal functional preservation up to 36 months.
  • This approach offers a reproducible strategy for maximizing parenchymal preservation while maintaining negative surgical margins.
  • Further prospective multicenter studies with longer follow-up are needed to confirm long-term durability and establish the role of MLR in routine practice.