Robotic versus Laparoscopic Partial Nephrectomy in the New Era: Systematic Review

Abstract

(1) Background: In recent years there have been advances in imaging techniques, in addition to progress in the surgery of renal tumors directed towards minimally invasive techniques. Thus, nephron-sparing surgery has become the gold standard for the treatment of T1 renal masses. The aim of this study is to investigate the benefits of robotic partial nephrectomy in comparison with laparoscopic nephrectomy. (2) Methods: We performed a systematic review according to the PRISMA criteria during September 2022. We included clinical trials, and cohort and case-control studies published between 2000 and 2022. This comprised studies performed in adult patients with T1 renal cancer and studies comparing robotic with open and laparoscopic partial nephrectomy. A risk of bias assessment was performed according to the Newcastle—Ottawa scale. (3) Results: We observed lower hot ischemia times in the robotic surgery groups, although at the cost of an increase in total operative time, without appreciating the differences in terms of serious surgical complications (Clavien III–V). (4) Conclusions: Robotic partial nephrectomy is a safe procedure, with a shorter learning curve than laparoscopic surgery and with all the benefits of minimally invasive surgery.

Minimising warm ischaemia time during robot-assisted partial nephrectomy. A video-based assessment of tumour excision, kidney reconstruction and intermediate time

“…For the LPN series, we observed that the longer the time taken to reconstruct the resection surface, the higher the probability of developing a complication. Guerrrero et al [12] showed similar complication rates for RAPN versus LPN in a recent systematic review, and we believe that a better kidney reconstruction was achieved using a robotic platform, although without any correlation with the rate of complications.…”

A Literature Review of Perioperative Outcomes of Robotic Radical Nephrectomy (RRN) Versus Laparoscopic Radical Nephrectomy (LRN) for Renal Cell Carcinoma (RCC)

“…A prospective comparison of RRN with LRN in many cases at multiple centres with long-term oncological results best illustrates the status of RRN versus LRN. Concerning the learning curve of these minimally invasive procedures, surgeons seem to have a longer learning curve with the laparoscopic approach in comparison to the robotic approach as highlighted by Guerrero et al [ 18 ]. Gab Jeong et al mentioned that RRN was linked to longer operative time and higher hospital cost when compared to LRN, but not associated with major post-operative complications [ 19 ].…”

Nephrectomies in Saudi Arabia: A Comprehensive Analysis of Outcomes from a High-Volume Minimally Invasive Surgery Center

“…The American Urological Association guidelines recommend partial nephrectomy as a first-line treatment for tumors between 4 and 7 cm in size—clinically classified as stage T1a or T1b—or for patients with absolute indications such as bilateral renal masses or a solitary kidney ( 2 ). Regardless of the type, nephrectomy has witnessed a significant shift toward minimally invasive surgery (MIS)—comprising laparoscopic and robotic approaches—in recent years due to its numerous advantages over traditional open surgery such as reduced perioperative blood loss and analgesia use, shorter hospital stay, quicker return to full function, and equivalent short- and long-term oncological outcomes ( 3 – 8 ). Both radical and partial nephrectomies can be performed openly or using minimally invasive laparoscopic and robotic approaches ( 9 ).…”