Robotic Vessel Sealer vs. Robotic Bipolar Grasper in Partial Nephrectomy

Robotic-assisted partial nephrectomy (RAPN) is widely used for nephron-sparing surgery. Vessel sealing technologies play a crucial role in these procedures, influencing ischemia time, blood loss, and surgical outcomes. This study compares the efficacy and safety of using a robotic vessel sealer (VS) versus conventional bipolar energy in robotic partial nephrectomy.

A retrospective analysis was conducted on patients (n = 112) undergoing RAPN using either a robotic VS or bipolar energy grasper between 2023 and 2025. Parameters analyzed included ischemia time, estimated blood loss (EBL), postoperative complications, and functional outcomes. Statistical comparisons were performed to assess differences in perioperative and postoperative metrics.

The vessel sealer (VS) group (n = 54) had significantly lower blood loss (40 mL vs. 132.5 mL, p = 0.037) than the bipolar group (n = 58). Ischemia time was similar (24.5 min vs. 20.46 min, p = 0.444). No significant differences were found in operative time, console time, docking time, or postoperative complications (p > 0.05). The tumor diameter (CT: 28.38 mm vs. 25.5 mm, p = 0.655; pathology: 2.34 cm vs. 1.96 cm, p = 0.375) and Radius-Exophytic/Endophytic-Nearness to collecting system or sinus-Anterior/posterior-Location relative to polar lines (RENAL) score (7.00 vs. 6.17, p = 0.202) were slightly higher in the bipolar group but not statistically significant.

Both techniques seem to be used for tumors of comparable size and complexity, suggesting no strong selection bias. Future research should prioritize randomized controlled trials assessing long-term renal function, cost-effectiveness, and potential refinements of robotic vessel sealing technology. A broader, multicenter analysis could provide further insight into optimal device selection for robotic partial nephrectomy.