Combined Laparoscopic-Robotic Partial Nephrectomy: A Comparative Analysis of Technical Efficiency and Safety

Background/Objectives: We aimed to evaluate the feasibility and safety of a combined approach to partial nephrectomy, which involves laparoscopic dissection for kidney as well as renal hilum mobilization, followed by robotic assistance for tumor resection and intracorporeal suturing, integrating the technical advantages of both laparoscopic and robotic surgery. Methods: We retrospectively analyzed 99 patients with clinical stage 1 renal tumors who underwent laparoscopic (LPN, n = 31), robot-assisted (RAPN, n = 16), or combined partial nephrectomy (CPN, n = 52) between 2016 and 2024. CPN involved laparoscopic mobilization of the kidney and renal hilum, followed by robotic tumor excision and intracorporeal suturing. Perioperative and postoperative outcomes were compared across groups. Results: Comparative analysis of the demographic characteristics of patients who underwent LPN, RAPN and CPN revealed no significant differences. The mean operative time (OT) was 126.75 ± 25.28 min for CPN, 121.9 ± 9.5 min for LPN (p = 0.014), and 155.5 ± 18.03 min for RAPN (p < 0.001). The median warm ischemia time (WIT) was 20.0 min (10.0-26.0) for CPN, which is comparable to RAPN at 18.5 min (14.0-23.0) (p = 0.158), but it was significantly longer for LPN at 23.0 min (18.0-28.0) (p < 0.001). The estimated blood loss (EBL) was 120.0 mL (50.0-350.0) for CPN, which is similar to RAPN at 110.0 mL (50.0-300.0) (p = 0.158), while it was higher for LPN at 180.0 mL (100.0-250.0) (p < 0.001). No major intraoperative or postoperative complications classified as Clavien-Dindo grade ≥3 were observed in any group. Conclusions: CPN is a feasible and safe approach for clinical stage 1 renal tumors, combining the efficiency of laparoscopy with the precision of robotics. Compared with LPN and RAPN, CPN showed comparable early oncological and functional results and had shorter operative duration and improved perioperative parameters.