Laparoscopic versus robotic nephrectomy: clinical outcomes, cost-effectiveness, and future innovations in minimally invasive renal surgery

Abstract

The management of renal pathology via nephrectomy has evolved from open surgery to minimally invasive techniques, with laparoscopic (LN) and robotic-assisted (RN) approaches now dominating. This review synthesizes 25 years of clinical evidence, comparing LN and RN in historical context, technical execution, outcomes, cost-effectiveness, and emerging innovations. LN, introduced in 1991, reduced morbidity and hospital stays but faced challenges due to technical limitations like 2D visualization. RN, enabled by the da Vinci system, improved precision with 3D imaging and wristed instruments, achieving lower complication rates (1.8% vs. 3.2% hemorrhage) and faster recovery, albeit at higher costs ($2,700 more per case). While LN remains cost-effective in resource-limited settings, RN excels in complex partial nephrectomies and obese patients. Current guidelines emphasize surgeon expertise and institutional resources for approach selection. Future directions include third-generation robotics, augmented reality, and AI integration to enhance precision and reduce costs. The review underscores that both techniques achieve excellent oncologic outcomes, with robotics poised to expand as technology evolves. 

Keywords: Laparoscopy, robotics, nephrectomy, artificial intelligence, outcomes, minimally invasive surgery