Multidisciplinary perioperative management of robot-assisted renal surgery: practical considerations for partial...

Robot-assisted surgery is established across urology, but its safety depends on more than console performance. Restricted access to the patient, limited tactile feedback, external arm collisions, phase transitions, and communication failures create risks that must be managed collectively. This narrative review summarizes multidisciplinary perioperative management for robot-assisted partial nephrectomy (RAPN) and robot-assisted nephroureterectomy (RANU) and introduces a proposed practice-based framework. The framework was developed by integrating multidisciplinary educational sessions and case-based discussions with a narrative synthesis of relevant literature. For RAPN, shared understanding of tumor localization, vascular-control and ischemia strategies when used, tumor excision, reconstruction when required, and hemostasis enables anticipatory preparation. For RANU, teams should anticipate transitions among renal, ureteral, and bladder-cuff phases, including possible redocking and changes in positioning or instruments. Across both procedures, recurring multidisciplinary tasks were organized into five functions: PLAN, POSITION, PREPARE, PERFORM, and PASS ON. These functions are intended to recur iteratively at critical transitions and to support shared situational awareness, closed-loop communication, emergency readiness, and structured postoperative handover. The proposed framework has not yet been validated; prospective studies should evaluate process measures, staff-reported outcomes, and patient outcomes.