Evolution of robotic assisted nephrectomy over time and comparison with laparoscopic assisted nephrectomy: a comprehensive literature review

Abstract

Abstract

Objectives: Radical Nephrectomy (RN) is the mainstay surgical treatment for localised kidney tumours not amenable to partial resection. A huge development in the surgical approach has been recorded with the first Laparoscopic Assisted Radical Nephrectomy (LARN) reported in 1991 and a little more than a decade later, the utilization of Robotic Assisted Radical Nephrectomy (RARN) has become popular worldwide. We aimed to compare the outcome of RARN vs LARN regarding safety, feasibility and efficiency.

Methods: A systematic review was conducted using PubMed, Cochrane, PMC PubMed central and Google Scholar using relevant search terms including nephrectomy, radical, robotic and laparoscopic. All papers published and available till January 2025 were included in our study.

Results: Across the included studies, operative time varied significantly between RARN and LARN. While early studies reported longer durations for RARN, more recent analyses have demonstrated narrowing differences, with some reporting comparable operative times. Variability was attributed to factors such as robotic docking time, higher BMI, and more complex cases in RARN cohorts. Estimated blood loss (EBL) was consistently lower in the RARN group, with studies reporting significantly reduced mean EBL. Length of hospital stay (LHS) was comparable or shorter with RARN in most studies, with some reports of successful same-day discharges. Postoperative pain management showed a trend toward reduced analgesia requirements in RARN, suggesting improved patient comfort. Complication rates were low and comparable in both groups, with some studies indicating a slight advantage for RARN in intraoperative and postoperative outcomes. Warm ischemia time (WIT), relevant in donor nephrectomy, was marginally longer with RARN but not clinically significant. Additionally, RARN demonstrated significant ergonomic benefits for the surgeon, reducing musculoskeletal strain and fatigue. However, the overall procedural cost for RARN remained higher, driven primarily by equipment and maintenance expenses.

Conclusion: Robotic Assisted Radical Nephrectomy has multiple advantages and can be even safer than the laparoscopic approach on comparing the perioperative outcomes. With wider usage and availability around the world, the cost-effectiveness of RARN will also improve.

Keywords: Nephrectomy, radical nephrectomy, robotic assisted nephrectomy, minimally invasive nephrectomy, renal cancer