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Updated: May 12, 2026
Robot-assisted Partial Splenectomy
Published on: January 2, 2026
Hemorrhage in Robot-assisted Partial Nephrectomy: A Multicentric, Retrospective Analysis of Blood Transfusion and
Olga Katzendorn1, Hamza Idais1, Mohammed R Kanaan1
1Department of Urology, Hannover Medical School, Hannover, Germany.
Background And Objective:
Postoperative bleeding in robot-assisted partial nephrectomy (RAPN) can result in a major complication. This study aims to identify factors associated with postoperative bleeding requiring an intervention (PBRI) as a major complication and predictors of blood transfusions as a minor complication.
Methods:
This study is a multicentric, retrospective analysis of 3726 RAPN cases. Separate comparative analysis was performed between: (1) patients with PBRI versus those without PBRI and (2) patients with blood transfusion versus those without blood transfusion. Two independent multivariable logistic regression analyses were performed to identify predictors for each endpoint.
Key Findings And Limitations:
PBRI occurred in 1.9% of patients and transfusion in 4.6%. Main interventions were angiography (49%) and operative revision (39%), with nephrectomy in 7.1% of patients. In both complication groups, patients were older (both p < 0.001), American Society of Anesthesiologists (ASA) scores were higher (both p < 0.001), and preoperative hemoglobin (Hb) was lower (both p < 0.05). Tumors in the transfused cohort were larger (p = 0.005), more frequently multiple (p = 0.01), and exophytic (p = 0.03). Patients with PBRI showed no difference in tumor characteristics. For both transfusion and PBRI, ischemia and operative time were longer (both p < 0.001) and surgeon's expertise was lower (both p < 0.05).Multivariable analysis showed a significant association of ASA score 3-4 (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.29-2.88, p = 0.001) and longer operative time (OR 1.07, 95% CI 1.04-1.11, p < 0.001) with transfusion, and longer ischemia time (OR 1.04, 95% CI 1.01-1.07, p = 0.01) with PBRI. Patient's age (p = 0.009 for PBRI; OR 1.03, 95% CI 1.01-1.04, p = 0.01 for transfusion) and lower preoperative Hb (OR 0.77, 95% CI 0.66-0.90, p = 0.001 for PBRI and OR 0.61, 95% CI 0.54-0.68, p < 0.001 for transfusion) were significantly associated with both complications.Main limitation of this study is its retrospective design.
Conclusion And Clinical Implications:
Most hemorrhagic complications after RAPN can be managed with kidney-preserving, multidisciplinary approaches. However, whether preoperative anemia correction is associated with improved outcomes should be investigated in future studies.
