Robotic partial nephrectomy and three-dimensional reconstruction in solitary kidneys: surgical and functional outcomes

Abstract

Background: Partial nephrectomy represents an absolute indication in patients with a solitary kidney, where preservation of renal function must be balanced against oncologic control. Robotic-assisted partial nephrectomy has expanded the feasibility of nephron-sparing surgery in complex tumors, while patient-specific three-dimensional reconstruction has emerged as a planning tool. This study evaluated the impact of robotic surgery and three-dimensional reconstruction on perioperative and functional outcomes in patients with a solitary kidney.
Methods: We retrospectively analyzed all solitary kidney patients who underwent partial nephrectomy between 2020 and 2024 at a tertiary referral center. Perioperative, oncologic, and renal functional outcomes (median follow-up: 12.0 months) were assessed according to surgical approach (robotic vs. open/laparoscopic). The impact of three-dimensional reconstruction was also explored. Acute kidney injury was defined according to Kidney Disease Improving Global Outcomes criteria.
Results: Twenty-seven solitary kidney patients were analyzed. Nineteen patients underwent robotic-assisted partial nephrectomy. Robotic surgery was associated with shorter hospital stay (median 4 vs. 8 days; P = 0.009), lower conversion to radical nephrectomy (0% vs. 37.5%; P = 0.01), and lower peak postoperative creatinine (1.6 vs. 4.7 milligrams per deciliter; P = 0.036). Acute kidney injury occurred in 50% of patients overall. Four patients treated robotically underwent three-dimensional-assisted planning and had significantly higher tumor complexity scores (P = 0.03). Three-dimensional reconstruction was independently associated with reduced length of stay and fewer postoperative complications but did not significantly affect renal functional outcomes.
Conclusion: Robotic-assisted partial nephrectomy in solitary kidney patients appears to offer perioperative advantages over open/laparoscopic approaches. Due to the small sample size, these findings should be considered preliminary and hypothesis-generating. Three-dimensional reconstruction appears to support surgical planning in anatomically complex tumors rather than demonstrating independent improvement in renal outcomes.

Keywords: Solitary kidney, partial nephrectomy, three-dimensional reconstruction, renal function, nephron-sparing surgery