Evaluating the Transition from 3D Laparoscopy to Robotic Partial Nephrectomy: Trifecta Achievement and Nephrometry...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Partial nephrectomy (PN) is standard for localized renal tumors, with surgical techniques evolving from 2D laparoscopy to 3D laparoscopy and robotic-assisted surgery.
• Evidence comparing 3D laparoscopy to robot-assisted partial nephrectomy (RAPN) during a complete transition is limited.

Purpose of the Study:

• To evaluate the safety and efficacy of transitioning from 3D laparoscopy to RAPN.
• To compare perioperative outcomes between 3D laparoscopy and RAPN in a single-surgeon series.

Main Methods:

• Retrospective study of 80 patients (36 3D laparoscopy, 44 RAPN) between 2018-2024, excluding the initial RAPN learning curve.
• Propensity score weighting was used to adjust for baseline differences between groups.

Main Results:

• RAPN cases involved more complex tumors (higher RENAL score: 8 vs. 6, p=0.001).
• Perioperative outcomes (hospital stay, operative time, complications) were comparable between 3D laparoscopy and RAPN.
• Warm ischemia time was significantly shorter in the RAPN group (17.5 vs. 22 min, p=0.005).

Conclusions:

• A complete transition from 3D laparoscopy to RAPN is safe and feasible.
• RAPN can maintain or improve outcomes, even for complex renal tumors, enhancing the applicability of nephron-sparing surgery.