A Systematic Review of Surgical Outcomes: Comparing Robotic-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Nephron-Sparing Surgery for Renal Tumors
Bibliographic record
Abstract
A partial nephrectomy is a critical approach for nephron-sparing surgery in renal tumors, striking a balance between oncological control and the preservation of renal function. Surgeons traditionally view open partial nephrectomy (OPN) as the gold standard in kidney surgery. The emergence of robotic-assisted partial nephrectomy (RAPN) offers a minimally invasive alternative that can improve surgical precision and decrease the risk of complications during the perioperative period. This systematic review analyzes and compares OPN and RAPN based on factors such as oncological effectiveness, preservation of kidney function, perioperative outcomes, and complication rates. We followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to review and include studies, analyzing 30 studies that involved more than 26,826 patients. The research team carried out retrospective and prospective cohort studies and randomized controlled trials (RCTs). They measured the quality of these studies by using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias tool version 2 (RoB 2; Cochrane, London, UK) for RCTs. Our findings indicate that RAPN offers significant perioperative advantages, such as reduced mean estimated blood loss (EBL) of 181 mL compared to 284 mL for OPN and shorter hospital stays averaging three days compared to six days for OPN. Follow-up durations ranged from three to 60 months. Although the surgery for RAPN takes longer, it consistently preserves renal function better, resulting in less considerable declines in the estimated glomerular filtration rate (eGFR). Oncological outcomes show that RAPN achieves a negative surgical margin (NSM) rate of 97.16%, while OPN reaches 92%. RAPN effectively handles complex renal tumors, especially those with high Preoperative Aspects and Dimensions Used for Anatomical (PADUA) or R.E.N.A.L. Nephrometry score (Radius (R), Exophytic/Endophytic properties (E), Nearness to the collecting system or sinus (N), Anterior/Posterior location (A), Location relative to polar lines (L)). In conclusion, RAPN offers significant advantages in perioperative and functional outcomes while maintaining oncological equivalence to OPN. This seals RAPN as the preferred approach in centers with robotic expertise. However, OPN remains a viable option in low-resource settings. Future research should improve access to robotic systems, standardize reporting metrics, and conduct long-term randomized trials to understand both techniques' strengths and limitations better.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".