A recent meta-analysis examined the perioperative outcomes of robotic-assisted partial nephrectomy in obesity (RPN), comparing it to open partial nephrectomy (OPN). With obesity becoming increasingly prevalent, it is crucial to assess how it impacts surgical procedures and patient recovery. The study analyzed data from three cohort studies, including 604 patients, to determine differences in hospital stay, blood loss, and complications. Findings revealed that robotic-assisted partial nephrectomy in obesity resulted in significantly shorter hospital stays, lower complication rates, and reduced estimated blood loss compared to open surgery. However, no significant differences were observed in transfusion rates, major complications, or operative times. These results suggest that robotic-assisted surgery offers a safe and effective option for obese patients undergoing partial nephrectomy.

Background

Renal cancer ranks as the eighth most prevalent cancer globally, with a steady rise in incidence by approximately 2% annually. Many renal tumors are small and incidentally discovered, leading to a growing preference for partial nephrectomy as a standard treatment. As technological advancements have increased the use of robotic-assisted surgeries, it is essential to evaluate their effectiveness, particularly in the context of rising obesity rates, which pose additional surgical challenges.

Literature Search and Methodology

Following PRISMA guidelines, the study was registered in the PROSPERO database, and trained researchers conducted a meticulous review of literature to select studies based on specific inclusion and exclusion criteria. Only English-language studies focusing on obese patients (BMI ≥ 30 kg/m²) undergoing either RPN or OPN were included. The analysis employed methods such as the Cochran-Mantel-Haenszel and random-effects models.

Results

The analysis involved three studies encompassing 604 patients—357 undergoing RPN and 247 undergoing OPN. Key findings included:

• Length of Hospital Stay (LOHS): RPN was associated with a significantly shorter hospital stay (WMD – 2.27, 95% CI – 3.67 to – 0.87; p = 0.002).
• Estimated Blood Loss (EBL): Patients undergoing RPN experienced less blood loss (WMD – 125.12, 95% CI – 198.02 to – 52.22; p = 0.0008).
• Overall Complications: RPN was linked to a lower incidence of overall complications (OR 0.50, 95% CI 0.34–0.73; p = 0.0004).
• Transfusion Rates and Major Complications: No significant differences were found in transfusion rates (OR 0.30, p = 0.06) or major complications (OR 0.97, p = 0.98).

Discussion

The study concludes that robotic-assisted partial nephrectomy in obesity is associated with shorter hospital stays and reduced blood loss, demonstrating its advantages over open surgery. The minimally invasive nature of RPN allows for quicker recovery and lower postoperative complications. Despite the advantages of robotic surgery, the analysis highlighted the ongoing challenges faced by obese patients, such as longer warm ischemia times and the need for further research to establish the long-term outcomes of RPN versus OPN.

Limitations

The meta-analysis acknowledges limitations, including a small sample size and the retrospective nature of the included studies. The potential for residual confounding and a lack of long-term outcome data were noted as significant gaps in the research.

Conclusions

RPN emerges as a safe and effective surgical option for obese patients, offering benefits like shorter hospital stays, reduced blood loss, and fewer complications. However, to validate these findings and assess long-term efficacy, larger, prospective randomized controlled trials with extended follow-up periods are necessary.

READ MORE… https://link.springer.com/article/10.1007/s11701-025-02237-0

Discover more about what GRASP can offer surgeons