This review examines the modern role of open partial nephrectomy (OPN), indications for this surgical approach, and outcomes associated with the open technique in the era of robotic surgery. Robotic-assisted partial nephrectomy (RAPN) now predominates for small renal masses and is increasingly applied to larger and more complex masses. Across multiple comparative series and meta-analyses, RAPN offers equivalent oncologic control and functional preservation compared to OPN, while demonstrating reduced perioperative morbidity. Nonetheless, OPN remains valuable for tumors in hostile or re-operative fields, certain hereditary syndromes, solitary kidneys when cold ischemia is preferred, and settings without reliable robotic access. Declining open case exposure during training raises concerns about maintaining surgical competency. OPN remains an important option when use of the approach provides improved surgical exposure, ischemia management, intra-operative safety, or feasibility of nephron sparing. A pragmatic, surgeon-experience-based approach that prioritizes oncologic control, parenchymal preservation, and patient safety best serves individualized care.

A predictive model from the Veterans Affairs National Health System estimates glomerular filtration rate (GFR) 1 year after partial nephrectomy (PN). The model demonstrated a coefficient of determination (R2) of 0.66, with 82% of patients having a postoperative estimated GFR within 30% of the predicted GFR (P30). The purpose of this study was to assess its performance in patients enrolled in the renal hypothermia trial. The model was externally validated using data from the renal hypothermia randomized clinical trial where GFR was measured using 99mTc-DTPA (technetium-99m-Tc-diethylenetriaminepenta-acetic acid) plasma clearance pre-PN and 1 year post PN. Model performance was evaluated using R2, calibration slope, calibration plot, and precision (P10: within 10%; P20: within 20%; and P30: within 30%). The trial cohort included 175 patients with pre-PN and post-PN complete data. The R2 was 0.67. The model was reasonably precise with 73 patients within 10% of predicted GFR (P10 = 41.7%), 129 within 20% of predicted GFR (P20 = 73.7%), and 156 within 30% of predicted GFR (P30 = 89.1%). The calibration slope was 1.04, with good calibration across a wide range of baseline renal function. Limitations include modest sample size, predominantly Caucasian patients, and restriction to open PN, limiting generalizability. A recently developed model to predict postoperative GFR performed well when applied to clinical trial patients who had GFR measured using 99mTc-DTPA plasma clearance. This model can be used as a component of informed decision-making when counseling patients on expected outcomes following partial nephrectomy.

Objectives: To identify predictors of these complications across open and robotic PN using an exploratory multivariable assessment. Methodology: A retrospective comparative cohort study was carried out at the Department of Urology, Pakistan Kidney and Liver Institute & Research Center, Lahore, where all adults undergoing open or robotic PN were included in the study from January 2020 to August 2025. Continuous demographic, clinical, and perioperative variables have been analyzed using IBM SPSS v27. Independent predictors of postoperative urine leak and hemorrhage will be evaluated using univariate comparisons and binary logistic regression, taking p < 0.05 as a threshold for significance. Results: A total of 117 patients were analyzed, including 15 (12.8%) robotic and 102 (87.2%) open PN cases. Tumor size was significantly larger in the open group (median 4.75 cm vs. 3.8 cm; p = 0.015), while operative time was longer in robotic PN (165 vs. 120 minutes; p = 0.071). Urine leak occurred in 6.8% of patients (6.7% robotic vs. 6.9% open; p = 0.978), and postoperative hemorrhage in 4.3% (0% robotic vs. 4.9% open; p = 0.381). Median hospital stay was comparable (2 vs. 3 days; p = 0.768). Logistic regression identified no independent predictors of either complication, though longer operative time showed a non-significant trend toward increased risk. Conclusion: Both open and robotic PN had comparable overall rates of postoperative urine leakage and haemorrhage. Therefore, when done on carefully chosen patients, both open and robotic PN can be considered safe.

Partial nephrectomy is increasingly favored for small renal masses due to its renal function-preserving benefits. This study compared contemporary utilization patterns, perioperative outcomes, and hospital costs of robotic-assisted (RAPN), laparoscopic (LAPN), and open partial nephrectomy (OPN) among U.S. patients with renal cancer. Using the 2016–2019 National Inpatient Sample, renal cancer patients undergoing RAPN, LAPN, or OPN based on ICD-10-CM/PCS codes were identified. Patient demographics, comorbidities, hospital characteristics, length of stay (LOS), perioperative complications, and hospital costs, were summarized by surgical approach. Regression analyses adjusted for patient- and hospital-level covariates were used to compare perioperative outcomes, LOS, and costs across procedures. An estimated 89,290 partial nephrectomies were identified (mean age 59.4 years; 60.4% male; 68.9% white). RAPN was the most common approach (63.4%), followed by OPN (22.6%) and LAPN (14.0%). Median hospital costs were lowest for LAPN ($14,627), compared with RAPN ($15,187) and OPN ($15,364). Both RAPN and LAPN were associated with lower odds of perioperative complications compared with OPN (RAPN: OR 0.48, 95% CI 0.43–0.55; LAPN: OR 0.51, 95% CI 0.43–0.61). RAPN was additionally associated with lower odds of blood transfusion, in-hospital mortality, and shorter LOS. After adjustment, hospital costs for RAPN and LAPN were not statistically significantly different from those for OPN. RAPN represents the predominant minimally invasive approach for partial nephrectomy in contemporary U.S. practice. Minimally invasive techniques offer clear clinical advantages over open surgery, with RAPN demonstrating more favorable intraoperative outcomes than LAPN. Future research should assess long-term functional, oncologic, and economic outcomes.

A0259 Robotic vs. open partial nephrectomy in complex cases: Real-world benchmarking of the OPERA trial

A0171 Two-year follow-up on oncological, functional und quality of life outcomes of the randomized ROBOt-assisted versus Conventional Open Partial nephrectomy (ROBOCOP) II trial

Impact of obesity on peri-operative outcomes at robotic-assisted, laparoscopic and open partial nephrectomy using national inpatient sample data.

Venous thromboembolic (VTE) complications contribute substantially to perioperative morbidity and mortality. The decision for mechanical and/or chemo-prophylaxis is currently based on VTE risk assessment models since conventional laboratory assays of coagulation usually fail to detect changes indicating hypercoagulability. Rotational thromboelastometry is a novel assay of coagulation, that it could potentially be used in objectively selecting patients at risk for VTE, who should indisputably undergo prophylaxis. We evaluated the association of conventional and novel assays of coagulation and VTE risk. VTE risk was preoperatively assessed in 45 patients scheduled for endoscopic, open and laparoscopic urologic surgery, including transurethral resection of prostate, transurethral resection of bladder tumor, endoscopic vesical or ureteral stone lithotripsy, open prostatectomy, open cystectomy and urinary diversion, open or laparoscopic radical or partial nephrectomy, between March 2021 and October 2022, using three different risk assessment models (RAMs): the European Association of Urology (EAU) RAM, the American Urological Association (AUA) RAM, and the Caprini model. Patients under antiplatelet or anticoagulation agents were excluded. Patients' coagulation profile was determined by measuring PT, fibrinogen, aPTT, and rotational thromboelastometry analysis. For rotational thromboelastometry analysis, extrinsic rotational thromboelastometry and fibrinogen rotational thromboelastometry were examined in every patient. Statistical analysis was performed with ANOVA test and χ2 test. Mean values of all rotational thromboelastometry variables did not vary significantly among different EAU VTE categories. In extrinsic rotational thromboelastometry assessment, a significant difference was observed in the mean values of the Clotting time (CT) between the different risk groups based on AUA RAM. In the comparison between the risk groups defined based on the Caprini score, statistically significant differences were observed in the extrinsic rotational thromboelastometry clot formation time (CFT). In fibrinogen rotational thromboelastometry analysis, significant differences were identified in the clot amplitude after five minutes (A5) and maximum clot firmness (MCF) indices between the AUA risk groups, along with a significant difference in the mean clot formation rate (CFR) value between the risk groups defined based on the Caprini score. Rotational thromboelastometry can provide a detailed evaluation of the hemostatic status in patients undergoing urologic surgery that can be used as an adjunct to the VTE risk assessment models and thus, help to offer prophylaxis on a rather personalized basis. Future studies should assess the utility of thromboelastometry in identifying patients at high risk for VTE after major urological procedures.

Comparing economic viability and peri-operative outcomes of open and robotic-assisted partial nephrectomy.

Robot-assisted partial nephrectomy (RAPN) is increasingly used to treat renal cell carcinoma (RCC), but randomized data comparing long-term outcomes to those after open partial nephrectomy (OPN) remain limited. Our aim was to compare oncological, renal function, and health-related quality of life (HRQOL) outcomes at 2yr for patients who underwent RAPN versus OPN. This single-center phase 2 randomized controlled trial included 50 patients with suspected localized RCC who were randomized 1:1 to RAPN or OPN. After 2-yr follow-up, we assessed overall survival (OS), recurrence-free survival, renal function, and HRQOL, including chronic postoperative pain and flank bulge. Analyses were conducted on an intention-to-treat basis. All but one patient completed oncological and renal follow-up, and 47 provided HRQOL data. At 2yr, overall survival was 100%, with one lymph-node recurrence in the RAPN group. The adjusted mean estimated glomerular filtration rate did not differ between the groups (OPN 74.1ml/min/1.73m2, 95% confidence interval [CI] 69.7-78.5; RAPN 75.8ml/min/1.73m2, 95% CI 71.3-80.1; p=0.59). HRQOL at 2yr remained high, with no significant difference in changes from baseline between the two groups. Chronic postoperative pain at the operative site (44% vs 0%; p=0.001) and flank bulge (32% vs 0%; p=0.007) were significantly more common in the OPN group versus the RAPN group. RAPN and OPN yielded excellent long-term outcomes. RAPN offers advantages in terms of postoperative morbidity without compromising renal function or QOL.

To evaluate the feasibility, and outcomes of partial nephrectomy (PN) for clinical T2b, T3a, and T3b renal mass in a high-volume tertiary care setting. We retrospectively analyzed patients who underwent open or robotic-assisted PN between 2017 and 2024 at a single academic center. Patients had imperative indications for PN [solitary kidney, chronic kidney disease CKD, bilateral neoplasm]. Data on perioperative outcomes, renal function, oncologic endpoints, and Trifecta achievement [no major surgical complications according to Clavien-Dindo classification (CD ≥ 3), negative surgical margins, 80% of estimated new baseline estimated glomerular filtration rate (eGFR)] were collected. Multivariable Firth logistic regression (MLRA) assessed predictors of failure to achieve Trifecta. We analyzed 103 patients with (12 T2b/88 T3a/3 T3b) renal mass (median tumor size 6.0cm/median R.E.N.A.L. score 10). Median ischemia time was 37.0min (cold in 45.6%, warm in 44.7% and segmental/clampless in 9.7%). Median blood loss was 200 mL. Major post-operative complications occurred in 20.4% [urine leak (9.7%), fluid collection (6.7%), hematoma (2.9%)]. Intraoperative complication rate was 1.9% (2 enterotomies). Microscopic positive surgical margins were observed in 10.7%; mean ΔeGFR was - 14.6ml/min/1.73m2. At median 38-month follow-up, 3-year overall, cancer-specific and recurrence-free survival rates were 92%, 94% and 75%, respectively. Trifecta was achieved in 43.7% patients. On MLRA, receipt of neoadjuvant therapy was associated with higher odds of failure to achieve Trifecta (OR 3.25, 95%CI 1.15-9.20; p = 0.03). PN for large and complex locally-advanced renal tumors is feasible with acceptable outcomes in carefully selected patients with imperative indication for nephron preservation. Further investigation is requisite to delineate role of PN in locally-advanced renal mass.

Background: Renal tumors are increasingly detected early due to widespread imaging. For localized tumors, particularly stage T1, partial nephrectomy (PN) is the standard of care, offering oncological efficacy while preservingrenal function. Laparoscopic partial nephrectomy (LPN) has been increasingly adopted, yet comparative outcomes with open partial nephrectomy (OPN) remain actively evaluated. Aim: To systematically review perioperative, functional, and oncological outcomes of LPN versus OPN in patients with localized renal tumors, including the impact of tumor anatomical complexity. Materials and Methods: A systematic literature search of PubMed identified comparative studies of LPN versus OPN for T1–T1b renal tumors. Extracted data included operative time, estimated blood loss, complications, renalfunction, oncological outcomes, and tumor complexity assessed by nephrometry scores. Results: LPN showed perioperative advantages, including reduced blood loss and shorter hospital stay, with operative time generally comparable to OPN in experienced centers. Early and long-term renal function, measured by estimated glomerular filtration rate, was similar between approaches. Oncological outcomes, including positive surgical margins, recurrence-free survival, cancer-specific survival, and overall survival, were equivalent. In anatomically complex or selected T1b tumors, LPN achieved acceptable perioperative and oncological outcomes when performed in experienced centers. Conclusions: Laparoscopic partial nephrectomy is a safe and effective alternative to open surgery for localized renal tumors, offering perioperative benefits without compromising renal function or oncological control. Tumor complexity and patient characteristics are more influential determinants of outcomes than surgical approach. LPN should be considered a standard option in centers with expertise in minimally invasive nephron-sparing surgery.

Correction: Robot-assisted vs open partial nephrectomy: a propensity-matched analysis of perioperative outcomes and midterm oncologic safety

Background/Objectives: The role of female surgeons in urology has been steadily increasing. We performed a contemporary review of American Board of Urology (ABU) case logs focused on oncologic procedures and evaluated the role of female surgeons over the past two decades. Methods: Operative logs from ABU examinees from 2003 to 2023 were analyzed. We identified open-approach (OA) and minimally invasive (MIS) radical nephrectomy (RN), partial nephrectomy (PN), radical nephroureterectomy (RNU), radical prostatectomy (RP), and adrenalectomy (RA) using CPT codes. Total case volumes as well as reported fellowship training were recorded and tabulated. The counts and proportions of OA and MIS procedures were analyzed over time and by surgeon gender. Results: From 2003 to 2023, 54,972 surgical procedures were reported to ABU with only 2.1% (1127) being performed by female surgeons. Of these, 32.5% (366) were OA and 67.5% (761) were MIS. Despite the low overall composition of female-performed procedures, the number of surgeries performed by females increased over time. Among female surgeons, the proportion of MIS surgeries increased over time, from 37.5% to 71.5% in 2003-2009 to 2017-2023, respectively. Females versus males performed comparably for OA for RN and RA; however, females performed more open PN, RNU, and RP than their male counterparts. Moreover, the number of procedures performed by oncology fellowship-trained females increased significantly. Conclusions: Our analysis of over twenty years of data submitted to the ABU indicates that the surgical volume of oncologic procedures by female urologists has been increasing. These findings demonstrate the increased contributions by female surgeons to the field urologic oncology.

Partial nephrectomy is the treatment of choice for T1 renal masses due to its nephron-sparing benefits. While open partial nephrectomy (OPN) has traditionally been the standard approach, laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive alternative. This quasi-experimental study was conducted in the Department of Urology at Bangabandhu Sheikh Mujib Medical University from February 2023 to August 2024 to compare short-term outcomes of OPN and LPN. A total of 26 patients with T1 renal masses were enrolled, with 13 undergoing OPN and 13 undergoing LPN. Operative duration, warm ischemia time, postoperative hemoglobin and serum creatinine levels, drain output, hospital stay, and resection margin status were evaluated. The two groups were comparable in terms of age, tumor size, and RENAL score. The OPN group demonstrated significantly shorter operative time and warm ischemia time compared to the LPN group (p=0.001), while postoperative hemoglobin and serum creatinine changes were similar between groups. However, drain output and length of hospital stay were significantly higher in the OPN group (p=0.001). All patients achieved negative surgical margins. In conclusion, both OPN and LPN are safe and effective for treating T1 renal masses, with LPN offering advantages in reduced drain output and shorter hospital stay, making it a favorable minimally invasive option in selected patients.

A female patient in the 70s presented with bilateral flank pain and haematuria. Evaluation confirmed tuberous sclerosis complex (TSC) with cutaneous findings, a giant renal angiomyolipoma (AML) in the patient's left kidney with a bleeding pseudoaneurysm, and a large mass in the right kidney containing distinct AML and high-grade renal cell carcinoma tumours. Situs inversus totalis was noted. Transarterial embolisation controlled the haemorrhage from the left kidney, followed by open partial nephrectomy on the right kidney to address the malignancy while preserving renal function. Everolimus was initiated post discharge to manage residual AMLs and lymphangioleiomyomatosis. Histopathology confirmed dual pathology in the right kidney. The patient recovered well, with stable renal function and resolved haematuria at 6 months. This case underscores the need for comprehensive imaging, histopathological confirmation and nephron-sparing strategies in managing complex renal pathologies in TSC, particularly with anatomical anomalies such as situs inversus.

Von Hippel Lindau (VHL) disease is a rare autosomal dominant disease with multi organ involvement. A 45yr old female, Known case of VHL with a diagnosis of renal cell carcinoma, pancreatic neuroendocrine tumour and spinal hemangioblastoma was scheduled for open partial nephrectomy. She underwent excision of cerebellar hemangioblastoma with ventriculoperitoneal shunt insertion 2 yrs back. During pre anesthetic check up, the functionality of ventriculoperitoneal shunt was confirmed radiologically and neuroendocrine tumor workup was done to rule out pheochromocytoma. Intraoperatively, the hemodynamic response was attenuated and care was taken during positioning and handling patients as it may have effects on ICP. Post operative pain was managed by continuous erector spinae plane infusion. Knowledge about the disease and associated lesions helped us to effectively manage perioperatively.

Robot-assisted versus open partial nephrectomy in renal tumor patients with chronic kidney disease: a meta-analysis of renal functional and perioperative outcomes.

Partial nephrectomy (PN) is preferred treatment for localized renal cell carcinoma (RCC), with shift toward robotic-assisted PN (RAPN) over open PN (OPN). However, high-quality comparative data remain limited. This study aimed to compare intraoperative, perioperative, and oncologic outcomes of RAPN versus OPN using a propensity score-matched cohort. In this retrospective, single-centre study, 386 patients underwent PN between January 2020 and December 2024. After applying exclusion criteria and propensity-score matching, 152 OPN cases were matched with 125 RAPN. Matching variables included age, Charlson Comorbidity Index, RENAL and PADUA scores, cT stage, and location. Primary endpoint was the intraoperative complication rate. Secondary endpoints included estimated blood loss (EBL), operative time, warm-ischemia time, length of hospital stay (LOS), postoperative complications rate (Clavien-Dindo classification), and 5-year oncologic outcomes (overall-survival [OS], cancer-specific survival [CSS], and recurrence-free survival [RFS]). RAPN was associated with a lower intraoperative complication rate compared to OPN (2% vs. 10%, p = 0.003). RAPN resulted in lower EBL (200mL vs. 300mL, p = 0.001), shorter operative time (147 vs. 170min, p = 0.001), and reduced LOS (median 6days, p = 0.001). Postoperative complications were less frequent with RAPN (14% vs. 25%, p = 0.01), with no significant differences in severe complications or positive surgical margins. Five-year OS, CSS, and RFS were similar between groups. RAPN provides significant perioperative advantages over OPN without compromising oncologic safety at 5years. These findings support broader adoption of RAPN in selected patients. Multicenter studies are warranted to assess cost-effectiveness, long-term functional outcomes, and generalizability.

Objective: The Mayo adhesive probability (MAP) score is used to predict the presence of adherent perinephric fat.The study aimed to assess the impact of MAP score on intra-and postoperative outcomes in partial nephrectomy (PN).Materials and Methods: This retrospective analysis encompassed 130 patients treated with either open or laparoscopic PN.MAP scores were calculated, and their relevance to intra-and postoperative characteristics was evaluated.Results: Cases were seperated into 2 groups according to MAP scores [group 1: MAP score 2 (n=86 (66.15%) and group 2: MAP score 3 (n=44 (33.85%)].No significant differences were observed in age, tumor size, body mass index, PN laterality, or radius, exophytic/endophytic, nearness, anterior/posterior location, and preoperative aspects and dimensions used for an anatomical nephrometry scores.Male patients, as well as those with higher American Society of Anesthesiologists scores (2) and Charlson comorbidity index (4), demonstrated significantly elevated MAP scores (p<0.001,p=0.046, p=0.022).Median operation time was longer [135 (interquartile range (IQR): 120-180) vs 160 (IQR: 140-180) min] in group 2 (p=0.014).Although duration of ) min] and intraoperative bleeding [400 (IQR: 200-700) vs 500 (IQR: 200-900) mL] were higher in group 2, no statistically significant difference was observed (p=0.262,p=0.352).No significant differences were observed regarding intra-and postoperative transfusion requirements or hospital length of stay.Conclusion: Elevated MAP scores are linked to longer operative times, while having a minimal effect on intra-and postoperative complications and outcomes.