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Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...

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Robot-Assisted Kidney Transplantation
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Is Open Partial Nephrectomy Still an Option in the Robotic Era?

Patrick Michael1, Ruben Blachman-Braun1, Lauren Loebach1

  • 1Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Current Urology Reports
|May 6, 2026
PubMed
Summary

Open partial nephrectomy (OPN) remains valuable for specific complex kidney tumor cases, even as robotic-assisted partial nephrectomy (RAPN) becomes standard. OPN offers advantages in challenging situations, ensuring oncologic control and kidney preservation.

Keywords:
Kidney cancerNephron-sparing surgeryOpen surgical techniquePartial nephrectomyRenal cell carcinomaRobotic surgery

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Robotic-assisted partial nephrectomy (RAPN) is now the predominant surgical approach for small renal masses.
  • RAPN is increasingly utilized for larger and more complex kidney tumors.
  • Comparative studies show RAPN offers oncologic and functional outcomes similar to open partial nephrectomy (OPN).

Purpose of the Study:

  • To review the current role of open partial nephrectomy (OPN).
  • To outline indications for OPN in the era of robotic surgery.
  • To assess outcomes associated with the open technique compared to robotic approaches.

Main Methods:

  • Review of comparative series and meta-analyses.
  • Analysis of outcomes data for OPN and RAPN.
  • Examination of specific clinical scenarios favoring OPN.

Main Results:

  • RAPN demonstrates reduced perioperative morbidity compared to OPN.
  • OPN remains crucial for tumors in difficult or re-operative surgical fields.
  • OPN is indicated for certain hereditary syndromes, solitary kidneys (preferring cold ischemia), and where robotic access is unreliable.
  • Declining open surgical training may impact surgeon competency.

Conclusions:

  • OPN is an important option when it offers superior surgical exposure, ischemia management, intra-operative safety, or feasibility of nephron-sparing surgery.
  • A pragmatic, surgeon-experience-based approach prioritizing oncologic control, parenchymal preservation, and patient safety is essential for individualized care.
  • Both OPN and RAPN have distinct roles in contemporary partial nephrectomy.