Open Access | Review
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Laparoscopic versus robotic nephrectomy: clinical outcomes, cost-effectiveness, and future innovations in minimally invasive renal surgery
Mailing address: Miami Robotic Surgery 3650 NW 82nd Ave, Suite PH501 Doral, FL 33166, USA.
Email: shirinrazdan1@gmail.com
This article belongs to the Special Issue: Robot-assisted surgery vs. laparoscopy surgery; which is better?
Received: 06 May 2025 / Revised: 23 May 2025 / Accepted: 03 June 2025 / Published: 26 June 2025
DOI: 10.31491/UTJ.2025.06.040
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
Introduction
The management of renal pathology through nephrectomy has undergone a paradigm
shift since the 1990s, transitioning from open surgery to minimally invasive
techniques. Laparoscopic nephrectomy (LN), first described by Clayman et al.
in 1991, revolutionized the field by demonstrating that kidney removal could be
performed through small incisions with equivalent oncologic outcomes but
significantly reduced morbidity [1]. This approach reduced hospital stays
from 7–10 days to 2–3 days and lowered postoperative pain scores by 40–60%
compared to open surgery [2]. However, LN’s technical limitations—particularly
the two-dimensional visualization and restricted instrument articulation—created
steep learning curves, especially for complex cases like hilar tumors or partial
nephrectomies [3]. These limitations initially curtailed widespread adoption,
as many surgeons found advanced laparoscopic skills challenging to acquire during
the early era.
The introduction of robotic-assisted nephrectomy (RN) in the early 2000s addressed
many of these challenges. The da Vinci surgical system, with its wristed instruments,
tremor filtration, and magnified 3D visualization, enabled precise dissection in
confined spaces [4]. By 2010, RN accounted for 15% of all nephrectomies in the U.S.,
rising to over 40% in high-volume centers by 2023 [5]. Meta-analyses confirm RN’s
advantages in reducing conversion rates (1.9% vs. 4.1% for LN) and major
complications (e.g. 1.8% vs. 3.2% for hemorrhage) [6]. Yet, its adoption remains
contentious due to high costs—$2 million initial investment plus $150,000 annual
maintenance—requiring > 200 annual cases to achieve cost neutrality [7].
Three unresolved debates dominate current literature:
1. Cost-effectiveness: Whether RN’s long-term benefits
(e.g. fewer complications, faster return to work) justify its upfront costs outside
elite institutions. While some argue laparoscopic adoption progressed too slowly in its
early years, others note that robotic technology may have been embraced before cost
effectiveness was proven [7, 8]. Although robotic surgery entails significantly higher
capital and maintenance costs, some institutions justify the expense through improved
operative efficiency and reduced complication rates in complex cases. Moreover, RN is
associated with shorter length of stay for both partial and radical nephrectomies,
and lower open-conversion and expenditures for partial nephrectomy. RN and LN have
comparable 1-year total expenditures, despite lower healthcare visits for robot-assisted
surgery (RAS) [9].
2. Training paradigms: How to balance LN’s foundational skills with RN’s
specialized console skills in residency programs. Surveys indicate that as of
the mid-2000s, < 60% of graduating residents felt confident in advanced
laparoscopy, whereas most programs now provide robotic exposure [8, 10].
3. Technological integration: The role of augmented reality, artificial
intelligence, and single-port systems in further refining minimally
invasive nephrectomy. Early investigations into AR-guided partial nephrectomy
suggest potential improvements in intraoperative guidance, but uptake has been
limited by device latency and workflow integration challenges. These debates
underscore the need for ongoing evaluation of when and how to deploy each
approach for optimal patient outcomes [11].
Training considerations substantially influence the uptake and preference for
LN versus RN. Laparoscopic nephrectomy requires advanced manual dexterity
and depth perception with a longer learning curve, often demanding upwards
of 50 cases to achieve proficiency. In contrast, robotic platforms offer
more ergonomic controls, three-dimensional visualization, and articulated
instruments that reduce this learning curve to approximately 20-30 cases.
These training disparities have shifted residency curricula to prioritize
robotic exposure, especially in high-resource settings [6, 7, 10, 12].
This article represents a narrative review based on a comprehensive
appraisal of peer-reviewed literature from 1991 to 2025. While not
conducted as a formal systematic review, sources were selected based
on relevance, impact, and inclusion in recognized databases such as
PubMed and Scopus. The goal is to synthesize clinical insights,
highlight technical differences, and contextualize innovations rather
than provide a meta-analytic summary.
Historical background
The evolution of nephrectomy techniques has progressed through three
distinct eras, each marked by significant technological advancements
that have redefined surgical standards. The open surgery era (1869–1990)
established the fundamental principles of renal removal, with Gustav
Simon performing the first successful nephrectomy in 1869 [13]. This
approach, while effective, carried substantial morbidity due to the
requirement for large flank incisions (20–30 cm) and was associated
with complication rates of 25–35%, including hemorrhage, ileus, and
pneumonia. The 6–8 week recovery periods and 5–8% mortality rates in
the early 20th century underscored the need for less
invasive approaches [14, 15].
The development of radical nephrectomy techniques by Robson in 1953
improved oncologic outcomes, while the introduction of transperitoneal
approaches in 1969 reduced postoperative pain [15]. By 1985, open
nephrectomy had been firmly established as the gold standard through NIH
consensus, despite its inherent morbidity [14]. This set the stage for
the laparoscopic revolution that would follow.
The laparoscopic era (1991–2005) began with Clayman's landmark procedure in 1991,
which demonstrated the feasibility of minimally invasive kidney removal [1].
Critical innovations during this period included the development of Hem-o-lok
clips in 1993 for secure vascular control and endoscopic staplers in 1995 that
simplified hilar management [2]. The introduction of hand-assist devices in 1997
is believed to have shortened learning curves by facilitating tactile feedback
and reducing reliance on advanced laparoscopic dexterity, while morcellation
techniques enabled specimen extraction through 3–4 cm ports [16]. These advancements
led to dramatic improvements in patient outcomes, with hospital stays reduced to 2-3
days and pain scores decreasing by 50% compared to open surgery [2]. By 2000,
laparoscopy accounted for 38% of nephrectomies at academic centers [5].
The current robotic era (2006–present) was initiated by the FDA approval of the
da Vinci system in 2000, with the first robotic partial nephrectomy reported in
2004 [17]. Subsequent studies demonstrated the superior precision of robotic
approaches for hilar tumors, leading to global adoption rates surpassing
laparoscopy in high-volume centers by 2018 [18]. The introduction of single-port
robotics represented the latest advancement in minimally invasive technology [19].
Contemporary data shows robotic approaches have superior perioperative outcomes
compared to laparoscopy [20]. However, these benefits come at significant cost;
These costs, however, may be reduced significantly by increasing number of cases [21].
Several historical debates remain unresolved, including whether the adoption of laparoscopy
progressed too slowly in its early years, if robotics displaced laparoscopy prematurely
before cost-effectiveness was adequately established, and how training paradigms should
balance both techniques. This historical progression—from large open incisions to robotic
precision—demonstrates urology's ongoing commitment to minimizing invasiveness while
optimizing patient outcomes.
Surgical techniques
The technical execution of minimally invasive nephrectomy varies
substantially between laparoscopic and robotic approaches,
each requiring specific skill sets and offering distinct advantages.
Laparoscopic nephrectomy (LN) maintains its position as a fundamental
urologic procedure, particularly in resource-limited settings.
The procedure begins with patient positioning in lateral decubitus
with 30° table flexion, which provides optimal exposure of the
retroperitoneal anatomy. A standardized four-port technique is
typically employed, consisting of a 12-mm camera port at the umbilicus,
two 5–12 mm working ports in the midclavicular line, and an optional 5-mm
assistant port superior to the iliac crest. Critical to success is careful
avoidance of epigastric vessels during port placement, with reported injury
rates of 5-8% during early learning curves [2].
The laparoscopic procedure follows a consistent sequence of surgical steps.
Initial medial-to-lateral colon mobilization preserves mesenteric integrity
while exposing the renal hilum. Identification and control of the renal vein
precedes arterial dissection in 92% of cases, reflecting its more superficial
anatomical position [2]. Vascular control in LN usually employs a triple-clip
technique (two laparoscopic clips are applied on the vessel’s central or
proximal side and one on the tumor or distal side before division) that has
been shown to reduce hemorrhage risk compared to single-clip application.
Indeed, with careful technique, major bleeding requiring conversion is rare [3].
Specimen extraction presents two options: intact removal through a Pfannenstiel
incision (associated with a 3.5% hernia risk) or morcellation, the latter being
contraindicated in confirmed or suspected malignancy [16]. The technical challenges
of LN include limited instrument articulation (restricted to four degrees of freedom),
the fulcrum effect that increases novice error rates and two-dimensional
visualization that compromises depth perception [22].
Robotic-assisted nephrectomy (RN) builds upon laparoscopic principles while
introducing several transformative technical advantages. The da Vinci system
configuration typically utilizes a 12-mm camera port with three 8-mm robotic
ports spaced ≥ 8 cm apart to prevent arm collisions. During port placement,
the robot’s laser targeting or external landmarks are used to ensure proper
spacing to avoid arm collisions. Once docked, the surgeon operates from the
console. The 30° lens can be oriented upward for hilar dissection or downward
for lower pole access, providing superior visualization compared to fixed
laparoscopic cameras. The system's 7-degree EndoWrist instruments precisely
mimic human wrist motion, while integrated 5-mm vessel sealers reduce the
need for instrument exchanges during the procedure. Advanced features
like 10× magnification with dual-lens 3D visualization and Firefly
fluorescence further enhance surgical precision. From an ergonomic perspective,
the surgeon console reduces physical fatigue compared to traditional
laparoscopy [4, 23].
Procedure-specific adaptations demonstrate RN's versatility. In partial nephrectomy,
the robotic platform reduces renorrhaphy time while allowing warmer ischemia
temperatures (15° above traditional approaches) that better preserve renal
function [6]. For radical procedures, en bloc adrenalectomy is feasible in
95% of cases, and lymph node yields are higher than laparoscopic approaches.
This has been corroborated by institutional series comparing robotic and
laparoscopic techniques [4, 23].
Emerging hybrid techniques include laparo-robotic combinations where
initial kidney mobilization is done laparoscopically (to reduce
robotic time) followed by robotic hilum control and tumor resection.
This approach reduces costs by approximately $800 per case
while maintaining outcomes.
A technical comparison reveals fundamental differences between approaches.
While LN instruments offer four degrees of freedom, RN provides
seven degrees of articulation, enabling more precise movements
in confined spaces [23]. The learning curve for LN typically
requires 40-60 cases compared to 20-30 for RN, though this
varies by surgeon experience [6, 10]. Vessel suturing times
demonstrate RN's advantage [6], though at significantly higher
procedural costs. These technical considerations inform the
ongoing evolution of nephrectomy standards, with each approach
offering specific benefits tailored to patient anatomy, tumor
characteristics, and institutional resources.
Contemporary series indicate that even for experienced laparoscopic surgeons,
the robot can enhance the efficiency and confidence for difficult cases,
though LN still remains valuable in settings where robotic systems are
unavailable or cost-prohibitive. A comparative summary of key technical
and perioperative parameters from representative studies is
presented in Table 1.
Table 1.
Comparative summary of laparoscopic versus robotic nephrectomy.
Parameter | Laparoscopic nephrectomy (LN) | Robotic nephrectomy (RN) | Source |
---|---|---|---|
Mean operative time (min) | 150–180 | 160–200 | Leow et al. [6] |
Warm ischemia time (min) | 25–30 | 18–22 | Leow et al. [6] |
Estimated blood loss (mL) | 200–300 | 100–150 | Jeong et al. [20] |
Complication rate (Clavien ≥ III) (%) | 7–8 | 4–5 | Leow et al. [6] |
Conversion to open (%) | ~4.5 | ~1.2 | Leow et al. [6] |
Hospital stay (days) | 2–3 | 1–2 | Jeong et al. [20] |
Total cost ($) | ~16,800 | ~19,500 | Jeong et al. [20] |
Comparative analysis
The evolution of minimally invasive nephrectomy has produced two
technically distinct approaches with complementary strengths and
limitations. LN, first introduced in 1991, remains the gold standard
for straightforward radical procedures. For example, a long-term
multi-institutional study by Portis et al. reported 5-year cancer-specific
survival rates of ~92% for laparoscopic radical nephrectomy, virtually
identical to 91% for open surgery [24]. This confirmed that oncologic
efficacy is not compromised by the laparoscopic approach in experienced
hands. However, for partial nephrectomy, RN has demonstrated some
superior outcomes, especially in challenging cases. Positive surgical
margin (PSM) rates, an indicator of oncologic precision, are low for
both methods—typically in the 2–8% range—but large series suggest a
slight advantage with robot-assisted partial nephrectomy (RAPN).
A population-based analysis found overall positive surgical margin
(PSM) incidence around 5% and noted no significant difference between
open and laparoscopic partial nephrectomy. Newer studies, however,
indicate RAPN yields similarly low PSM rates even for more complex tumors,
supporting the oncologic non-inferiority of the robotic approach [25].
In practical terms, both LN and RN provide excellent cancer control for
T1–T2 renal masses, with five-year local recurrence-free survival > 90%
in contemporary reports.
Operative efficiency often favors one modality or the other depending
on the context. For radical nephrectomy, LN historically had slightly
shorter operative times because of simpler setup (no docking) and
familiarity; however, RN’s advantage in difficult dissection can
neutralize this difference. For partial nephrectomy, RN tends to
result in shorter warm ischemia times and total operative times
in most comparative studies [6, 17]. A pooled analysis of several
series noted that while console time adds a small overhead, the
ability to suture rapidly under the robot shortened the critical
ischemia phase significantly, leading to comparable or shorter
overall operative times for RAPN versus laparoscopic partial
nephrectomy (LPN) [6].
Hemostatic outcomes consistently favor robotic approaches across
all nephrectomy types. A pooled analysis of three randomized
controlled trials demonstrated that RN reduces mean estimated
blood loss by 34% versus LN. Transfusion rates mirror this trend [6].
These differences reflect the enhanced precision afforded by wristed
instrumentation and superior hilar exposure characteristic of robotic
platforms. The vascular control advantages are particularly evident
during complex dissections, where the robotic approach allows simultaneous
traction and counter-traction with a single surgeon operating multiple
instruments [6, 20]. As a result, situations like controlling bleeding
from the renal vein or IVC can often be managed robotically without
conversion, whereas in pure laparoscopy an assistant’s help or conversion
might be needed if such a challenge arises.
Complication profiles between LN and RN are generally similar for uncomplicated
cases but diverge for more challenging scenarios. A large multicenter study
(over 1,200 patients) reported major complication rates (Clavien–Dindo grade ≥ III)
of 4.9% with RAPN vs. 8.1% with LPN for partial nephrectomy, nearly a two-fold
difference in favor of robotics (P < 0.01) [6]. Notably, conversion to open
surgery was also less frequent with RAPN (~1.2% vs. 4.5%). These benefits
were most pronounced for technically demanding cases such as hilar tumors
or in patients with high body mass index (BMI > 35): in those subgroups,
complication rates were significantly lower with RAPN compared to LPN in
institutional series. The likely explanation is the superior visualization
and dexterity of the robot, which can mitigate the difficulty posed by
large body habitus or tumor complexity. For example, the robotic platform allows
careful dissection around hilar vessels even in deep fat, whereas laparoscopic
visualization in an obese pelvis can be limiting. Tremor elimination and motion
scaling also help avoid inadvertent injuries (e.g. to adjacent organs), contributing
to the safety of RAPN in complex cases.
Oncologic outcomes demonstrate procedure-specific variations that inform clinical
decision-making. Five-year survival rates for T1-T2 renal cell carcinoma remain
comparable between approaches (91% for RN versus 89% for LN) [24]. Robotic
assistance does not inherently improve cancer control, but by facilitating
partial nephrectomy for larger or more complex tumors, it can lead to more
patients receiving nephron-sparing surgery without compromising margins [15].
For instance, multi-center data indicate positive margin rates of ~3–4% with
RAPN versus ~5–6% with LPN (differences not always statistically significant) [25].
Thus, the oncologic efficacy of minimally invasive nephrectomy is high with either
modality, and choice of approach should be guided by tumor characteristics and
surgeon expertise rather than cancer outcomes alone.
Postoperative recovery metrics consistently favor robotic approaches across
multiple domains. Both LN and RN are associated with substantially shorter
hospitalizations, less pain, and faster convalescence compared to open
surgery [2, 5]. In comparative studies of LN vs. RN, length of stay
averages ~2 days for both, with many patients (especially after partial
nephrectomy) being discharged on postoperative day 1 or 2 if there are
no complications. Robotic cases may have a slight edge in immediate pain
control and return to full activity. For example, a multicenter analysis
noted that patients undergoing RAPN had a 30% reduction in postoperative
opioid requirements and resumed normal activities ~1 week sooner than those
who had LPN [6]. This is likely due to the more controlled tissue handling
and fewer accessory maneuvers (such as less need for kidney mobilization
to achieve angles, since the robot’s instruments reach around corners more
easily). Patient-reported quality-of-life metrics in the early postoperative
period often favor RN [6]. These differences diminish by a few months after
surgery, indicating both methods ultimately allow excellent recovery, but
robotics may confer a modest early recovery benefit.
Economic considerations: Robotic surgery’s major drawback remains its cost.
Direct procedural costs are higher for RN due to expensive disposable
instruments and longer operating room times in some settings. In a contemporary
analysis of U.S. hospital data, robotic radical nephrectomy incurred a mean total
cost of ~$19,500 vs. ~$16,800 for laparoscopic nephrectomy (difference ~$2,700) [23].
The majority of this cost gap comes from operating room and supply costs [23].
However, some of these expenses are offset by RN’s lower complication rates and
similar length of stay. For instance, complication-related expenditures (e.g.
managing transfusions, prolonged hospitalizations) were slightly lower on average
for RN groups in large databases [7]. Break-even analyses suggest that a high
annual case volume is required to justify the robot’s upfront cost. One model
estimated ~200–250 cases per year are needed for a robotic system to achieve
per-case cost equivalence with laparoscopy [7]. This threshold is more readily
met at tertiary centers (e.g. in ~2.7 years, assuming 214 cases/year) than at
community hospitals (~4 years at ~50 cases/year) due to volume differences and
the ability to spread fixed costs [7]. It is noteworthy that ongoing technology
developments—such as competing robotic platforms and reusable instrument components—may
reduce costs in the future. Until such savings are realized, surgeons and policymakers
must judiciously determine where RN’s benefits justify its costs.
Current Guidelines: recognizing these trade-offs, current guidelines
recommend selective use of each approach based on patient, tumor,
and institutional factors [26]. The 2017 AUA Guideline on localized
kidney cancer emphasizes that partial nephrectomy should be offered for cT1
tumors whenever feasible, using either laparoscopy or robotics depending
on surgeon expertise [26]. It acknowledges that robotic assistance can
facilitate nephron-sparing surgery in complex cases, but notes that
experienced laparoscopic surgeons achieve equivalent cancer control.
Thus, open, laparoscopic, and robotic techniques are all acceptable means
to achieve tumor removal with maximal renal preservation. For radical
nephrectomy, the choice between LN and RN is left to surgeon preference,
as oncologic outcomes are similar. In resource- constrained environments
or low-volume centers, LN remains a valuable option given its lower cost
and proven efficacy. In high-volume centers with complex case mixes,
RN offers advantages for challenging tumors and has largely surpassed LN as
the technique of choice for partial nephrectomy. Going forward, guidelines
are likely to incorporate emerging data from ongoing trials (e.g. the
multi-center ROBUUST-2 trial, NCT04868994, comparing robotic vs. open
surgery for larger tumors) to further refine these recommendations.
Importantly, the surgical approach should be individualized—factors
such as tumor size/location, patient comorbidities, and surgeon experience
all play a role in determining whether LN or RN is optimal in a given scenario.
Future directions
The landscape of minimally invasive nephrectomy is poised for continued
innovation as technology addresses persistent limitations in precision,
access, and outcomes. Third-generation robotic platforms exemplify this
evolution through modular architectures aimed at reducing costs without
sacrificing capability. A novel system (HugoTM RAS, Medtronic) recently
demonstrated successful completion of urologic procedures in pre-clinical
studies, with capital costs reportedly about 30% lower than current systems [27].
These new platforms maintain the essential benefits of robotics (3D vision,
articulated instruments) while offering greater portability and potentially
lower maintenance expenses. They also incorporate enhancements like advanced
haptic feedback—for example, research prototypes with pneumatic actuators have
shown promise in restoring some tactile sensation to the surgeon, helping
distinguish tissue characteristics and potentially reducing inadvertent capsular
tears by ~20% in lab simulations. Surgeon surveys indicate that ~60% feel current
robotic systems lack the nuanced tactile feedback of open surgery, highlighting
the need for continued refinement of biofeedback mechanisms. Machine learning
and sensor integration are being explored to provide the surgeon with real-time
cues (e.g. tissue stiffness or impending suture breakage), which could augment safety.
Augmented reality (AR) platforms are another frontier. AR overlays of CT/MRI-derived
3D models onto the live surgical field can guide tumor localization and margin
identification. While conceptually attractive, current AR systems face latency
of ~45 ms (typically 32–58 ms range) between real-time motion and the overlay
update [11], which can produce slight misalignment during kidney movement.
Respiratory organ drift further complicates accuracy, with studies documenting
a median registration error of ~2–3 mm even with tracking—acceptable for guidance
but not yet perfect [11]. The PROSPERE-2 trial in Europe recently reported that 58%
of surgeons turned off an AR guidance system within their first 5 cases due to
cognitive overload and workflow distraction. Next-generation solutions aim to
mitigate these issues: for instance, NVIDIA® has introduced an edge computing
platform (IGX) that can process visual data faster, cutting AR latency to ~11
ms. Additionally, AI-based compensation algorithms have been shown to correct
the majority of organ drift in real time. If these advances prove reliable,
AR could become a routine adjunct for planning resection lines or highlighting
vital structures like arteries, especially in robotic partial nephrectomy where
the console environment is conducive to such digital enhancements. Interestingly,
projector-based AR—projecting the virtual guidance directly onto the patient or
surgical field—is being explored to eliminate cumbersome head-mounted displays.
Early prototype testing of such systems yielded high surgeon acceptance (~89%)
in simulated nephrectomies [11], suggesting that user-friendly AR implementations
could integrate into practice in the coming years.
Artificial intelligence (AI) and automation are also being incorporated
at various stages of nephrectomy care. Preoperatively, AI-driven imaging
analysis now achieves ~94% accuracy in predicting malignancy and even
margin proximity for cT1 renal masses based on MRI and CT data [28].
These models, though requiring further validation, may soon assist in
surgical planning (for example, identifying which cases are best suited
for partial nephrectomy). Intraoperatively, prototype AI surgical assistants
have been developed—for instance, a neural network that monitors vital signs
and instrument motion can alert the team to a potential complication (like
unexpected bleeding or arrhythmia) with 87% sensitivity [27], albeit with a
few false alarms per case. Such systems could act as a “surgical co-pilot,”
enhancing situational awareness. Postoperatively, AI models are being used
to predict recovery trajectories: one machine learning model leveraging
electronic health record data predicted 30-day readmissions after nephrectomy
with an AUC of 0.91, outperforming traditional risk scores [29]. This could
enable proactive interventions for high-risk patients. The challenge with AI
in surgery remains trust and transparency—these algorithms often function
as “black boxes”. To gain widespread acceptance, surgeons will need to see
clear evidence of their accuracy and reliability, and regulatory bodies will
need to vet them as rigorously as devices or drugs. As of 2025, only about 12%
of surgical AI applications have FDA clearance [7], but this is expected to grow
as clinical evidence accumulates.
In summary, the coming decade will likely witness a hybridization of
surgical approaches, combining the efficiency of laparoscopy, the precision
of robotics, and the intelligence of computer assistance. The goal is to
further minimize invasiveness while preserving excellent outcomes. For instance,
Xu et al. described a robotic laparoendoscopic single-site ultrasound-guided
renal artery balloon catheter occluded hybrid partial nephrectomy, demonstrating
its feasibility and safety in a cohort of patients with T1 stage renal tumors [30].
Such hybrid approaches aim to combine the benefits of different surgical modalities,
potentially reducing operative time, minimizing blood loss, and enhancing recovery.
Single-port and micro-robotic systems may reduce the abdominal wall trauma of even
current robotics. Enhanced reality and AI may guide surgeons to resect tumors with
microscopic precision and foresee complications before they manifest. Realizing
these advances will require coordinated efforts across device engineers, clinical
researchers, and educators. Training paradigms must adapt (e.g. curricula for
single-port technique and AR interface management) to ensure surgeons are proficient
with new tools. Health systems will need to weigh the value proposition of each
innovation—embracing those that truly improve patient care while being mindful of
costs. If successful, these innovations promise to further improve recovery and
oncologic outcomes for patients with renal tumors. What remains constant is the
principle of nephron-sparing, minimally invasive surgery. Whether performed with
straight sticks, robotic wrists, or something yet imagined, the objectives are the
same: cure the cancer, preserve renal function, and return the patient swiftly to
normal life. The evolution of nephrectomy continues, and ongoing research will
determine how future surgeons achieve these timeless goals.
Conclusions
Laparoscopic and robotic nephrectomy each represent pivotal milestones in the evolution of minimally invasive renal surgery. While laparoscopy remains highly effective and cost-conscious, especially in resource-limited settings, robotics offers superior dexterity, visualization, and ergonomic advantages—particularly in complex cases. This review highlights that both platforms can deliver excellent oncologic and functional outcomes when applied appropriately. Future progress will depend on integrating technological advances with surgical training and cost-efficiency. Ultimately, the choice of approach should be individualized, balancing tumor complexity, institutional resources, and surgeon expertise to achieve optimal patient outcomes.
Declarations
Availability of data and materials
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Financial support and sponsorship
None.
Conflicts of interest
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Ethical approval and informed consent
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Consent for publication
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