Research evolution of ischemia management and vascular control strategies in robot-assisted partial nephrectomy: a...

Ischemia management and vascular control remain central to robot-assisted partial nephrectomy (RAPN), yet the development and knowledge structure of this research field have not been systematically characterized. We performed a bibliometric and knowledge-mapping analysis of English-language articles and reviews retrieved through a Title-field search of the Web of Science Core Collection, covering database inception to July 16, 2026. Bibliometrix/Biblioshiny, VOSviewer, CiteSpace, and OriginPro were used to examine publication and citation trends, collaboration networks, journal and reference co-citation, and thematic evolution. Among 162 publications, comprising 157 articles and 5 reviews, output remained uneven but increased after 2021, peaking at 17 publications in 2023; annual citations also peaked in 2023 at 382. The United States was the largest contributor and collaboration hub, with Italy forming another major center, although research activity remained concentrated among a limited number of countries, institutions, and author groups. The intellectual structure was shaped by studies of ischemic injury, renal functional preservation, tumor complexity, and standardized outcome assessment. Research emphasis evolved from hypothermia, nephron-sparing surgery, and warm ischemia toward selective and off-clamp strategies, indocyanine green guidance, enucleation, and anatomy-informed renal preservation. These findings indicate a shift from a predominantly time-centered view of ischemia toward a broader framework integrating vascular territory and parenchymal preservation. However, bibliometric prominence does not establish clinical superiority, and no single clamping strategy is supported as universally optimal. Future studies should standardize ischemic-exposure reporting, focus on operated-kidney function, and evaluate patient- and anatomy-specific net clinical benefit.