New paradigm in robotic partial nephrectomy: planned outpatient surgery in all patients

We previously published the first series of routine overnight robotic partial nephrectomy (RPN) in 2013 that was successful in 97% of patients. We initiated selective outpatient RPN in 2018 and since 2020 began uniformly performing RPN on a planned outpatient basis regardless of age, comorbidities, or tumor complexity. We present our pioneering experience with planned outpatient RPN in all patients, which has never previously been reported for RPN. We reviewed our single-surgeon (RA), prospective database of 300 consecutive RPN procedures from March 2020-May 2025. Outpatient RPN with same day discharge (SDD) home from the recovery room was planned in all patients regardless of patient or tumor characteristics or surgery time of day. Length of stay, complications and readmissions were assessed. A total of 304 RPNs were performed in 300 patients with 292 discharged home the same day (97.3%) as planned. SDD rate increased over time, reaching 100% by year #3. Mean age was 60yrs (28-85yrs), mean BMI was 32 kg/m² (18-59 kg/m²), mean tumor size was 3.5 cm (1-10.5), and mean RENAL score was 7.3 (4-11) with 19% hilar tumors. Only 6 were single-port procedures (294 multiport). RPN was retroperitoneal in 46%. No drains were used. Mean recovery room stay was 2.0 h in hospital patients and 1.4 h in ASC patients. Five 30-day readmissions occurred (1.7%) with only one within 24 h such that only one readmission would have been avoided by uniform overnight admission. No Clavien III-V complications occurred including urine leaks, postoperative hemorrhage, or transfusions. Truly outpatient RPN with routine SDD from the recovery room is safe and feasible when outcomes are reliable and surgeon experience provides a predictably low risk of complications. Readmission rates were comparable or better than published series using routine overnight or longer stays. Experienced surgeons with rare early complications should consider offering outpatient RPN.