Robotic assisted partial nephrectomy in the treatment of small renal masses: a literature review

Abstract

Background and Objective: The diagnosis of patients with small renal masses (SRMs) has increased, as has the use of robotic surgery in their treatment. Our objective is to review the role of robotic partial nephrectomy (PN) in the management of SRM. Methods: Articles were selected from 2005–2022 on PubMed and MEDLINE databases using the keywords: “robotic-assisted partial nephrectomy”, “laparoscopic partial nephrectomy” and “small renal masses”. Key Content and Findings: Existing researches revealed that relative to open partial nephrectomy (OPN), robotic-assisted partial nephrectomy (RAPN) has less significant (Clavien-Dindo ≥2) complications: 8% vs. 25% (P<0.001). Also, lower estimated blood loss (100 vs. 400 mL; P<0.001), shorter length of stay (median 5 vs. 6 days; P<0.001), and lower risk of active kidney injury were found in the RAPN group. In regards to positive surgical margins, no significant difference was found between RAPN and OPN. When comparing RAPN and laparoscopic partial nephrectomy (LPN), RAPN had a shorter warm ischemia time (P=0.005), a shorter length of stay (P=0.004) and a lower reduction in estimated glomerular filtration rate (P=0.03). In Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) <10 tumors, a research pointed out a lower risk of positive margins in RAPN vs. LPN (odds ratio 0.59; 95% confidence interval: 0.35–0.99; P=0.04). Safety outcomes were even more promising in very SRM (<2 cm) with robotic-assisted approach. Conclusions: RAPN provides higher rates of trifecta outcomes when compared to OPN and LPN in the treatment of SRM. Whilst active surveillance and FT remain valid options for unfit patients, RAPN, whenever an active treatment is indicated, stands as a safe approach with excellent outcomes.