Robotic and open partial nephrectomy preserved function similarly in a solitary kidney

Design

Systematic review and meta-analysis of retrospective cohorts

Population

333 patients with a tumour in a solitary kidney

Primary outcome

12-month eGFR preservation, temporary dialysis, CKD progression

Effect

eGFR MD −3.8% (−10.7 to 3.2); dialysis OR 1.80 (0.47–6.90)

A meta-analysis pooled four retrospective cohorts comparing robot-assisted and open partial nephrectomy in 333 patients with a tumour in a solitary kidney.

There was no difference in 12-month eGFR preservation (mean difference −3.8%, 95% CI −10.7 to 3.2), temporary dialysis (OR 1.80, 0.47–6.90) or progression of CKD stage (OR 1.42, 0.67–3.00). The robotic approach had slightly shorter warm ischaemia (about 2 minutes), earlier discharge (about 2.4 days) and less blood loss, with no difference in complications or positive margins.

The studies are few, retrospective and likely affected by selection, since surgeons choose which tumours to approach robotically. The intervals for dialysis are wide. For nephrologists, the practical point is that the approach matters less than the surgeon's experience, and that close follow-up of kidney function is needed either way.

• Refer patients with a tumour in a solitary kidney to an experienced nephron-sparing surgical team.
• Plan for possible temporary dialysis and discuss it before surgery.
• Monitor eGFR closely for the first year after partial nephrectomy in a solitary kidney.
• Treat the robotic advantages in stay and blood loss as modest and possibly selection-driven.

Why it matters

In a solitary kidney there is no reserve, so any operative injury shows directly in kidney function.

Don't overread it

Four small retrospective studies cannot establish equivalence between the approaches.

The statistics, in plain English

All three primary intervals cross no difference, so the study cannot tell the approaches apart on kidney function. With only 333 patients, a real difference could have been missed.

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