LAUSR

Robotic-assisted partial nephrectomy (RAPN) was first described about 15 years ago [1], in an era where standard laparoscopy still represented the main player in the field of minimally invasive surgery. Nowadays, this procedure is becoming de facto the new “gold standard” for nephron sparing surgery, given its recognized advantages compared to its open and laparoscopic counterparts [2, 3] (Fig. 1). In this special issue of World Journal of Urology, we collected a series of reports from leading institutions in the field on hot topics in RAPN. A transperitoneal approach has been primarily adopted in most centers pioneering RAPN [4, 5], because of key advantages from surgeon’s perspective, such as the larger working space and the easier recognition of anatomical landmarks. However, the use of retroperitoneal approach has recently emerged, given the potential clinical benefits it might offer to patients [6]. As the transition from one approach to the other seems challenging, Dr. Abaza and colleagues share their experience how they transitioned from transperitoneal to retroperitoneal RAPN without much difficulties and no identifiable learning curve [7]. Looking at the same subject from the perspective of a pioneer in the retroperitoneal approach, Dr. Porter and his team report a “matched paired” analysis from their center [8]. Besides the approach, two key issues in the field of RAPN is how to manage the renal hilum, and how to deal with the reconstruction after tumor removal. Whether or not clamping the hilum is still be debated, and the existing large body of literature does not allow firm conclusions [9]. Antonelli et al. looked at the safety profile of one or the other approach by analyzing data from the only randomized trial ever reported on the topic (CLOCK trial; NCT02287987) [10]. While part of the current debate has been centered around tumor resection techniques [11], emphasis is now placed also on renorraphy techniques, and investigators from Indiana University address the stimulating question about whether a single layer renorrhaphy may be associated with improved postoperative renal function [12]. As the indications of robotic nephron-sparing surgery are rapidly expanding [13], it is important to compare the outcomes of RAPN to those of the traditional standard open partial nephrectomy. To this end, Dr. Derweesh and colleagues report the largest reported comparison of RAPN and open partial nephrectomy for clinical T2a renal tumors [15]. In summary, our idea was to fuel the debate on key issues by providing the readers with the latest stimulating research about the ongoing developments in the field. We hope to be able to fulfill this idea.