Evaluating the Transition from 3D Laparoscopy to Robotic Partial Nephrectomy: Trifecta Achievement and Nephrometry Score Differences

Abstract

Background: Partial nephrectomy (PN) is the standard treatment for localized renal tumors where nephron preservation is feasible. The evolution of minimally invasive surgery has progressed from conventional two-dimensional laparoscopy to three-dimensional (3D) laparoscopy and, more recently, to robotic-assisted techniques. Although robotic and laparoscopic PN have been widely compared, evidence focusing on a complete transition from 3D laparoscopy to robot-assisted partial nephrectomy (RAPN) remains scarce. Methods: This retrospective single-surgeon study included 80 consecutive patients treated between 2018 and 2024, encompassing the full transition period from 3D LPN to RAPN. Thirty-six patients underwent 3D laparoscopy and forty-four underwent robotic surgery, excluding the first ten robotic cases representing the learning phase. Propensity score weighting was applied to minimize baseline differences. Results: Tumors treated with RAPN had significantly higher RENAL scores (median 8 vs. 6, p = 0.001), indicating greater complexity, while perioperative outcomes—including hospital stay, operative time, and complication rates—remained comparable. Warm ischemia time was significantly shorter in the RAPN group (17.5 vs. 22 min, p = 0.005), and the TRIFECTA rate was higher though not statistically significant. Conclusions: These results indicate that a complete transition from 3D laparoscopy to robotic partial nephrectomy is safe and feasible, maintaining or improving outcomes even in more complex tumors and broadening the applicability of nephron-sparing surgery.