Endophytic Renal Cell Carcinoma Treated with Robot-Assisted Surgery: Functional Outcomes – A Comprehensive Review of the Current Literature

Introduction: Robotic surgery for the management of localized renal cell carcinoma (RCC) has gained increasing popularity during the last decade. An endophytic renal tumour represents a surgical technical challenge in terms of identification and resection related to the lack of external visual cues on the kidney surface. Materials and Methods: There is little evidence of functional outcomes of robotic surgery on treating endophytic masses. For this reason, we wanted to review the contemporary literature on the functional outcomes of endophytic RCC treated with robotic surgery. Results: Many studies investigating robotic partial nephrectomy for totally endophytic RCC confirmed the good functional results of this approach at intermediate follow-up. The greater relative importance of volume loss versus ischaemia duration in predicting long-term renal function after partial nephrectomy is now established, and the robotic technique may facilitate volume preservation. Accurate use of intra-operative ultrasonography, enucleation, and intra-operative techniques using near-infrared fluorescence imaging with indocyanine green dye could minimize excision of the parenchyma and prevent devascularization of adjacent healthy parenchyma. Conclusions: Unfortunately, the overall quality of the literature evidence and the high risk of selection bias limit the possibility of any causal interpretation about the relationship between the surgical technique used and functional outcomes.