Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review

In comparison to standard resection, pooled analysis revealed an advantage with tumor enucleation in terms of avoidance of renal artery clamping, complications, length of stay, and renal function. These data should be considered when planning the strategy for resecting a renal tumor. The resection technique used to excise tumor during robotic partial nephrectomy (RPN) is of paramount importance in achieving optimal clinical outcomes. To provide an overview of the different resection techniques used during RPN, and a pooled analysis of comparative studies. The systematic review was conducted according to established principles (PROSPERO: CRD42022371640) on November 7, 2022. A population (P: adult patients undergoing RPN), intervention (I: enucleation), comparator (C: enucleoresection or wedge resection), outcome (O: outcome measurements of interest), and study design (S) framework was prespecified to assess study eligibility. Studies reporting a detailed description of resection techniques and/or evaluating the impact of resection technique on outcomes of surgery were included. Resection techniques used during RPN can be broadly classified as resection (non-anatomic) or enucleation (anatomic). A standardized definition for these is lacking. Out of 20 studies retrieved, nine compared “standard” resection versus enucleation. A pooled analysis did not reveal significant differences in terms of operative time, ischemia time, blood loss, transfusions, or positive margins. Significant differences favoring enucleation were found for clamping management (odds ratio [OR] for renal artery clamping 3.51, 95% confidence interval [CI] 1.13–10.88; p = 0.03), overall complications (OR for occurrence 0.55, 95% CI 0.34–0.87; p = 0.01) major complications (OR for occurrence 0.39, 95% CI 0.19–0.79; p = 0.009), length of stay (weighted mean difference [WMD] −0.72 d, 95% CI −0.99 to −0.45; p