Robot-assisted partial nephrectomy: systematic review of functional results

Curr Opin Urol. 2018 Mar;28(2):123-131. doi: 10.1097/MOU.0000000000000482.


Purpose of review: Various ischemia type during partial nephrectomy for renal cell cancer (RCC) resulted in different postoperative functional outcomes. Our objective was to systematically review the contemporary literature on robot-assisted partial nephrectomy (RPN) and investigate the association of ischemia type and tumor complexity with postoperative functional outcomes of the operated kidney and overall.

Recent findings: Forty-five of the 99 reports identified were selected for qualitative analysis. All included studies were observational and nonrandomized. Overall, we found that patients undergoing RPN with zero ischemia and selective artery clamping had a lower decrease in glomerular filtration rates of the operated kidney in comparison to both warm and cold ischemia. This association seems also to play a role in patients with bilateral kidneys harboring complex tumors.

Summary: Zero ischemia and selective artery clamping provide the best functional outcomes following robotic partial nephrectomy. This seems to be of particular relevance in patients with single kidney or tumors of high complexity. Whether these changes are statistically or clinically significant cannot be determined within this systematic review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Carcinoma, Renal Cell / pathology
  • Carcinoma, Renal Cell / surgery*
  • Glomerular Filtration Rate
  • Humans
  • Ischemia / diagnostic imaging
  • Ischemia / epidemiology
  • Ischemia / etiology
  • Ischemia / physiopathology*
  • Kidney / blood supply
  • Kidney / diagnostic imaging
  • Kidney / physiopathology
  • Kidney / surgery
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / surgery*
  • Nephrectomy / adverse effects
  • Nephrectomy / instrumentation
  • Nephrectomy / methods*
  • Observational Studies as Topic
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology*
  • Postoperative Period
  • Preoperative Period
  • Radionuclide Imaging / methods
  • Renal Artery / surgery
  • Retroperitoneal Space / surgery
  • Robotic Surgical Procedures / adverse effects
  • Robotic Surgical Procedures / instrumentation
  • Robotic Surgical Procedures / methods*
  • Solitary Kidney / diagnostic imaging
  • Solitary Kidney / etiology
  • Solitary Kidney / physiopathology*
  • Treatment Outcome