Three-Arm Versus Four-Arm Configurations in Robot-Assisted Partial Nephrectomy: A Systematic Review and Meta-Analysis

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted partial nephrectomy (RAPN) is a key procedure for kidney cancer.
• Two common configurations are three-arm and four-arm setups.
• Existing comparative data on outcomes is inconsistent.

Purpose of the Study:

• To quantitatively compare perioperative, functional, and oncological outcomes between three-arm and four-arm RAPN.
• To synthesize current evidence on the efficacy of different RAPN configurations.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched multiple databases (PubMed, Embase, Scopus, Web of Science, Cochrane).
• Included studies comparing three-arm vs. four-arm RAPN; used MD and RR for analysis; assessed risk of bias with ROBINS-I.

Main Results:

• Five studies included; no significant differences found in blood loss, ischemia time, transfusion rates, or complication rates.
• No significant difference in positive surgical margins between the two configurations.
• Length of stay showed no consistent difference upon sensitivity analysis.

Conclusions:

• Three-arm and four-arm RAPN yield comparable perioperative, functional, and oncological outcomes.
• The choice between three-arm and four-arm RAPN depends on surgeon preference, institutional resources, and case complexity.
• Both configurations are effective for partial nephrectomy in kidney cancer treatment.