Outcomes of Robotic Radical and Partial Nephrectomy

Since the advent of the first laparoscopic nephrectomy in 1990 by Clayman et al., the use of the robotic platform has revolutionized the performance of minimally invasive renal surgery. Over the last decade, the robotic platform as allowed partial nephrectomy to become more feasible due to improved visualization and hilar dissection, as well as expedient tumor excision and renorrhaphy. More recently the retroperitoneal approach has also become a popular option, with surgeons relying on the retroperitoneal approach for posterior and lateral tumors as well as in those patients with hostile abdomens. A systematic review from 2020 comparing robotic radical nephrectomy with laparoscopic and open nephrectomy found longer operative time, shorter length of stay, fewer overall complications, lower estimated blood loss (EBL), and higher total hospital costs. The data on robotic partial nephrectomy shows that the robotic approach results in mixed outcomes for warm ischemia time (WIT), although it is associated with shorter hospital length of stay and shorter operative times when compared to laparoscopic and shorter hospital stay with longer operative times compared to open approach. The retroperitoneal approach appears to be a technically feasible procedure for surgeons who are already familiar with the robotic transperitoneal approach. It may result in faster operative times with shorter length of stay compared to transperitoneal partial nephrectomy without attendant increase in complication rate or positive surgical margin rate.