Grosso Antonio Andrea, Salamone Vincenzo, Di Maida Fabrizio, Giudici Sofia, Cadenar Anna, Lambertini Luca, Conte Francesco Lupo, Bacchiani Mara, Mazzola Luca, Crisci Alfonso, Oriti Rino, Vittori Gianni, Fantechi Riccardo, Tuccio Agostino, Mari Andrea, Minervini Andrea
Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy.
Asian J Urol. 2025 Apr;12(2):210-216. doi: 10.1016/j.ajur.2024.09.010. Epub 2025 Jan 25.
Nowadays robot-assisted partial nephrectomy (RAPN) represents the standard of care for clinical T1 (cT1) renal masses, providing similar oncological outcomes when compared to open or laparoscopic PN with advantages in terms of functional outcomes and lower perioperative comorbidity, when compared to radical nephrectomy.
We performed an extensive literature review of studies regarding RAPN, its evolution, technical aspects and applications, and new technological tools using different combinations of Medical Subject Headings terms "RAPN", "partial nephrectomy", "robot-assisted", "nephron-sparing surgery", "renal cell carcinoma", "complex renal masses", "endophytic renal masses", and "bilateral renal tumors".
A consistent body of evidence was selected, including original articles, systematic reviews, meta-analyses, and clinical trials having RAPN as the central focus in adult patients, with all its technical nuances. We started our narrative review with a background on PN and its evolution toward the robotic era with a special spotlight on the extending indications for PN in large and highly complex renal masses. Our review continued with an overview of nephron-sparing surgery in bilateral and recurrent masses. RAPN for bilateral synchronous renal masses represents a challenging scenario with no formal recommendations provided by international guidelines and controversial management and decision-making. Additionally, we reported evidence on redo RAPN which seems to be safe and effective. A final overview of the available technological tools, and in particular on three-dimensional reconstruction was provided.
RAPN has been established as the standard of care for cT1 renal masses with an expanding spectrum of applications in different scenarios, including large (cT2), highly complex, and bilateral renal masses, as well as the surgical treatment of local recurrences after nephron-sparing surgery with acknowledged advantages in terms of functional outcomes and perioperative risk profiles while maintaining similar oncological outcomes when compared to open or laparoscopic PN and radical treatment.
如今，机器人辅助部分肾切除术（RAPN）是临床T1（cT1）肾肿瘤的标准治疗方法，与开放性或腹腔镜下部分肾切除术相比，其肿瘤学结局相似，与根治性肾切除术相比，在功能结局和降低围手术期合并症方面具有优势。
我们使用医学主题词“RAPN”、“部分肾切除术”、“机器人辅助”、“保留肾单位手术”、“肾细胞癌”、“复杂肾肿瘤”、“内生性肾肿瘤”和“双侧肾肿瘤”的不同组合，对有关RAPN、其发展、技术方面和应用以及新技术工具的研究进行了广泛的文献综述。
我们筛选了一系列连贯的证据，包括以RAPN为成年患者核心关注点及其所有技术细节的原创文章、系统评价、荟萃分析和临床试验。我们在叙述性综述开始时介绍了部分肾切除术的背景及其向机器人时代的发展，特别关注在大型和高度复杂肾肿瘤中部分肾切除术的扩展适应症。我们的综述接着概述了双侧和复发性肿瘤的保留肾单位手术。双侧同步肾肿瘤的RAPN是一个具有挑战性的情况，国际指南未提供正式建议，管理和决策存在争议。此外，我们报告了再次RAPN的证据，其似乎是安全有效的。最后提供了可用技术工具的概述，特别是三维重建。
RAPN已被确立为cT1肾肿瘤的标准治疗方法，在不同情况下的应用范围不断扩大，包括大型（cT2）、高度复杂和双侧肾肿瘤，以及保留肾单位手术后局部复发的外科治疗，在功能结局和围手术期风险方面具有公认的优势，与开放性或腹腔镜下部分肾切除术和根治性治疗相比，同时保持相似的肿瘤学结局。
