Robot-assisted and embolization-assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal...

The optimal surgical approach for renal angiomyolipoma (AML) remains uncertain. Robot-assisted partial nephrectomy (RAPN) and selective arterial embolization before laparoscopic partial nephrectomy (SAE + LPN) have been proposed to improve perioperative outcomes compared with conventional laparoscopic partial nephrectomy (LPN). However, their relative advantages in AML-specific populations have not been systematically assessed. We performed a systematic review and meta-analysis of observational studies comparing RAPN with LPN and SAE + LPN with LPN. Major databases, including PubMed, Embase, Web of Science, Cochrane Library, Scopus, and CNKI, were searched up to September 25, 2025. Pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models. Seven studies met the inclusion criteria, including three comparing RAPN and LPN and four comparing SAE + LPN and LPN. RAPN was associated with significantly shorter warm ischemia time (MD = - 5.09 min; 95% CI [- 6.15 to - 4.03]; p < 0.001), reduced hospitalization time (MD = - 0.43 days; 95% CI [- 0.80 to - 0.06]; p = 0.02), and higher postoperative eGFR (MD = + 3.20 mL/min/1.73 m²; 95% CI [0.90 to 5.50]; p = 0.006) compared with LPN. SAE + LPN showed significantly shorter operative time, warm ischemia times and reduced intraoperative blood loss compared with LPN (all p < 0.001). RAPN shortens ischemia and recovery times, while SAE + LPN demonstrated reductions in operative time, warm ischemia time, and intraoperative blood loss. Other perioperative outcomes did not consistently differ across studies. Both represent valuable minimally invasive options for AML and support individualized surgical planning. These findings may guide future evidence-based recommendations for AML management.