Search Results (219)

Background/Objectives: To compare perioperative, pathological, functional, and oncological outcomes of robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy (RARN-TT) versus open (ORN-TT) and laparoscopic (LRN-TT) approaches. Methods: PubMed, Scopus, and Web of Science were searched for studies of adults with renal cell carcinoma and Mayo/Neves level I–IV inferior vena cava tumor thrombus undergoing RARN-TT versus ORN-TT and/or LRN-TT. Risk ratios and mean differences with 95% confidence intervals were calculated using random effects models with restricted maximum-likelihood estimation. Results: Eight retrospective studies including 1781 patients were included: 221 underwent robotic surgery, 1411 open surgery, and 149 laparoscopic surgery. Compared with ORN-TT, RARN-TT was associated with lower estimated blood loss (mean difference −900.5 mL, 95% confidence interval −1234.0 to −566.9; p = 0.001), lower transfusion probability (risk ratio 0.395, 95% confidence interval 0.159–0.979; p = 0.046), and shorter hospital stay (mean difference −3.79 days, 95% confidence interval −4.83 to −2.76; p < 0.001). No significant differences were observed in operative time, intensive care unit stay, postoperative complications, perioperative mortality, pathological outcomes, or overall survival. Evidence for cancer-specific and progression-free survival was limited. Comparisons with LRN-TT were exploratory. Conclusions: RARN-TT may reduce blood loss, transfusion requirements, and hospital stay compared with ORN-TT, without evidence of worse perioperative, pathological, or survival outcomes. However, all studies were retrospective and affected by selection bias and heterogeneity. RARN-TT may be considered for selected patients at experienced centers, particularly for lower-level thrombi. Prospective multicenter studies stratified by thrombus level are needed. Full article

Deep learning-based surgical vision systems achieve strong performance in semantic segmentation and phase recognition, but their black-box nature limits traceability in safety-critical clinical settings. Prototype-based networks offer an interpretable alternative by grounding predictions in learned visual exemplars, yet their suitability for surgical video understanding remains insufficiently characterized. We adapted a prototype-based architecture to two surgical datasets, laparoscopic cholecystectomy and robot-assisted minimally invasive esophagectomy (RAMIE), and benchmarked it against conventional baselines. We evaluated a segmentation-only setting, in which prototype size and capacity were ablated, and a multitask setting, in which three strategies for coupling prototype learning to semantic segmentation and surgical phase recognition were compared. Prototype-based models underperformed the conventional baselines across both tasks and datasets. In the segmentation-only setting, the selected prototype configurations achieved Dice scores of 72.23% on Cholecystectomy and 72.07% on RAMIE, compared with 74.35% and 74.02% for the corresponding conventional baselines, and showed weaker boundary agreement. In the multitask setting, the best prototype strategy recovered competitive segmentation performance but remained 6–12 F1 points below the conventional baseline for phase recognition. Qualitatively, prototype activation maps exposed intra-structure decompositions and contextual cues that are not directly available from black-box baselines. Prototype networks provide spatially traceable evidence for surgical scene understanding, but currently trade interpretability for reduced boundary precision and phase-recognition performance. These findings motivate future work on scene-level and temporally aware prototypes for explainable surgical AI. Full article

Background/Objectives: The opioid epidemic has increased awareness of inpatient opioid use after surgery. Effective pain control is essential for recovery; however, factors influencing postoperative opioid requirements (PORs) remain unclear. This study examined patient-specific factors and surgical platforms associated with postoperative rescue opioid use within 48 h of bariatric surgery. Methods: A retrospective chart review was conducted on patients undergoing bariatric surgery (Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG)) from March 2021 to March 2023 at a community hospital setting. Data included demographics, comorbidities, psychiatric history, prior surgeries (cholecystectomy, hernia repair, other bariatric surgery), intraoperative parameters, postoperative disposition, hospital length of stay, and PORs measured in morphine milligram equivalents (MME). Robotic and laparoscopic surgery were compared and risk factors for increased PORs were analyzed. Results: Among 442 patients (86.7% women, mean age 42.1 ± 12.0 years), robotic procedures (51.6%) had higher PORs than laparoscopic procedures (13.3 ± 13.2 versus 10.1 ± 11.2 MME; p < 0.01), mainly driven by the SG group (14.8 ± 13.3 versus 9.2 ± 9.6 MME, respectively; p < 0.01). In multivariable logistic regression, robotic surgery (OR 1.38, 95% CI: 1.02–1.88, p = 0.041), psychiatric history (OR 1.67, 95% CI: 1.11–2.51, p = 0.014), and prior surgery (OR 1.52, 95% CI: 1.03–2.24, p = 0.034) were associated with increased PORs (>10 MME). No significant differences were observed based on sex, type of procedure (SG vs. RYGB), or body mass index. Conclusions: In this study, robotic surgery was associated with higher PORs. Preoperative psychiatric evaluation and multimodal pain management strategies may assist in the optimization of analgesia in patients with psychiatric conditions or prior surgery. Full article

Background/Objectives: Intraoperative ultrasound (IOUS) has become an integral component of modern hepatic oncology surgery, providing real-time imaging guidance during liver resections for hepatocellular carcinoma, colorectal liver metastases, and other primary or secondary hepatic malignancies. Despite substantial improvements in preoperative imaging modalities, occult lesions, disappearing metastases after chemotherapy, and complex vascular relationships continue to represent major intraoperative challenges. This structured narrative review aimed to evaluate the contemporary role of IOUS in hepatic oncology surgery, with particular emphasis on contrast-enhanced intraoperative ultrasound (CE-IOUS), minimally invasive liver surgery, navigation-assisted hepatectomy, and emerging artificial intelligence-based technologies. Methods: A structured literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases. Peer-reviewed studies, international guidelines, consensus statements, systematic reviews, and technological reports addressing IOUS applications in liver surgery were analyzed. Particular focus was placed on studies evaluating lesion detection, intraoperative strategy modification, disappearing colorectal liver metastases, parenchymal-sparing hepatectomy, laparoscopic and robotic liver surgery, navigation systems, augmented reality integration, and AI-assisted imaging technologies. Results: Contemporary evidence demonstrates that IOUS continues to significantly influence intraoperative decision-making despite advances in magnetic resonance imaging and multidetector computed tomography. CE-IOUS improves the detection of occult hepatic lesions and residual disease after systemic chemotherapy, particularly in disappearing colorectal liver metastases. IOUS-guided anatomical and parenchymal-sparing resections contribute to the preservation of functional liver parenchyma while maintaining oncologic radicality. In minimally invasive liver surgery, laparoscopic ultrasound remains essential for lesion localization and vascular mapping. Recent developments integrating navigation systems, augmented reality platforms, and AI-assisted image recognition suggest a progressive transition toward digitally integrated precision liver surgery. Conclusions: IOUS remains a cornerstone of modern hepatic oncology surgery and continues to evolve from a localization tool into a comprehensive platform for precision-guided liver resection. The integration of CE-IOUS, navigation technologies, and artificial intelligence may further enhance intraoperative accuracy, oncologic safety, and individualized surgical planning in the future. Full article

The rapid advancement of robot-assisted minimally invasive surgery (RAMIS) has created an increasing demand for integrated solutions that combine advanced robotic actuation, sensing, and intelligent control within unified training and operational frameworks. This paper presents a Digital Twin–based virtual reality (VR) interaction and control system developed for an innovative parallel surgical robot, designed to support both surgical training and real-time robot interaction. The proposed framework extends a conventional VR simulator into a bidirectional Digital Twin architecture, enabling real-time synchronization between a virtual environment and the physical robotic system. The system integrates the ATHENA parallel robot, characterized by a 4-degree-of-freedom architecture with a Remote Center of Motion (RCM) constraint, together with a flexible laparoscopic instrument providing enhanced dexterity. Interaction is achieved using VR controllers, allowing intuitive manipulation of the robotic system within an immersive environment. To enhance operational performance, an artificial intelligence module based on neural networks is integrated as an assistive component, providing real-time trajectory refinement and motion guidance. The trained model is deployed using an ONNX-compatible runtime, ensuring efficient inference and seamless integration within the control architecture. The proposed system is validated through experimental evaluation of user interaction and task execution performance, as well as through external motion assessment using an OptiTrack optical tracking system. The results demonstrate improvements in motion stability, execution efficiency, and user interaction quality, while maintaining a high level of control intuitiveness. The findings highlight the potential of Digital Twin–based VR systems as a unifying platform for surgical training, interaction, and intelligent assistance in next-generation medical robotic systems. Full article

Background: Efficient and safe instrument exchange remains an important challenge in robot-assisted laparoscopic surgery (RALS). Current workflows require human assistance, increasing staff workload and contamination risk. The modular design of the AdLap robotic laparoscopic instruments enables automated exchange of instrument shafts. This study presents the development and validation of the Instrument Carousel Exchange System (ICES). Methods: An automatic ICES was developed for the AdLap robotic surgery platform of the Delft University of Technology. The prototype was designed to hold six Shaft-Actuated Tip-Articulating (SATA) modular instrument shafts (SATA instrument line, SATA Medical, Amsterdam, The Netherlands) and focused on compactness, robustness, modularity, and rapid disassembly for cleaning and sterilization. System performance was evaluated using repeated autonomous instrument exchange cycles without user interaction. Reliability, alignment tolerance, safety, and exchange duration were assessed. Results: The ICES prototype was successfully designed, manufactured, and tested. Repeated functional testing demonstrated reliable autonomous instrument shaft exchange without human intervention. The system tolerated minor alignment deviations while maintaining stable and safe operation. The mean time for a complete instrument shaft exchange was 84 s (SD = 10 s). The modular architecture allowed straightforward disassembly and maintenance while preserving structural integrity and compact design. Conclusions: The developed ICES represents a substantial step toward fully automated modular instrument handling in RALS. Automated instrument exchange may reduce staff workload and minimize contamination risk during procedures. Future work will focus on improving automation speed, alignment efficiency, and autonomous reinsertion of the instrument shaft through the trocar to further enhance clinical applicability. Full article

Background: The utilization of robot-assisted surgery in pediatric patients is increasing, with particularly notable advantages in complex reconstructive procedures. This study aims to evaluate the safety and efficacy of robotic-assisted resection of choledochal cysts in infants aged less than 3 months. Methods: A total of 73 infants with choledochal cysts who were admitted to the Department of General Surgery, Children’s Hospital of Zhejiang University School of Medicine, between April 2019 and December 2025 were included. The patients were divided into a robotic-assisted surgery (RAS) group (n = 39) and a laparoscopic-assisted surgery (LAS) group (n = 34). Clinical data, including demographic information, laboratory indexes, surgical data, and prognostic data, were retrospectively reviewed, and the Mann–Whitney U test, independent-samples t-test, and Fisher’s exact test were used for statistical analysis. Results: The groups were comparable in terms of age, sex, weight, pre- and postoperative biochemical markers, fasting time, cyst diameter, and operative time. Overall, 80.8% of cases were prenatally detected. The RAS group had a significantly shorter postoperative hospital stay (p = 0.004, Z = −2.864), drainage tube duration (p = 0.002, Z = −3.100), and hepaticojejunostomy time (p < 0.0001, df = 71, 95%CI (−5.70, −3.04)) compared to the LAS group. In the LAS group, three patients developed anastomotic fistulas, all of whom required reoperation, and one patient developed adhesive bowel obstruction, whereas in the RAS group, one patient developed incision infection, one developed cholangitis, one developed adhesive bowel obstruction, and one presented with postoperative liver function abnormalities. The hospitalization cost in the LAS group was significantly lower than that in the RAS group (p < 0.0001, Z = −5.468). Conclusions: In experienced pediatric centers, robotic-assisted resection of choledochal cysts is safe and effective for infants aged less than 3 months and deserves further exploration. Full article

Background: Minimally invasive surgery has become the standard of care in colorectal cancer management, with laparoscopic techniques widely adopted due to their established short-term benefits and comparable oncological outcomes to open surgery. More recently, robotic-assisted surgery has emerged as an advanced minimally invasive alternative, offering enhanced visualization, improved instrument dexterity, and superior ergonomics. However, the extent to which these technical advantages translate into clinically meaningful improvements remains a subject of ongoing debate. Methods: A systematic review of the literature was conducted using PubMed, Scopus, and Web of Science databases, including studies published between 2005 and 2025. Eligible studies comprised randomized controlled trials, observational studies, cohort studies, and meta-analyses comparing laparoscopic and robotic colectomy for colon cancer. Outcomes of interest included intraoperative parameters (operative time, blood loss, conversion rate), postoperative outcomes (length of hospital stay, complications, mortality), and oncological endpoints (lymph node yield, resection margins, survival). The review was performed in accordance with PRISMA 2020 guidelines. Results: A total of 150 studies met the inclusion criteria. Robotic colectomy was consistently associated with reduced intraoperative blood loss, lower conversion rates to open surgery, and shorter length of hospital stay, albeit at the expense of longer operative times, particularly during the learning phase. Oncological outcomes, including lymph node harvest and margin status, were comparable between approaches, with some studies reporting a modest increase in lymph node yield in robotic procedures. The adoption of intracorporeal anastomosis was significantly higher in robotic surgery, contributing to improved postoperative recovery and reduced wound-related complications. Composite quality metrics, such as textbook outcome (TO), were more frequently achieved in robotic cohorts, largely driven by shorter hospitalization and lower complication rates. However, evidence from randomized controlled trials remains limited, and heterogeneity among studies persists. Conclusions: Robotic colectomy and rectal resection represent a safe and effective alternative to laparoscopic surgery in the treatment of colon cancer, offering potential advantages in perioperative outcomes and surgical precision. Its benefits appear particularly relevant in technically demanding cases, such as deep pelvic dissection and obese patients. Nevertheless, higher costs, longer operative times during the initial learning curve, and limited high-quality randomized evidence warrant cautious adoption. Future large-scale randomized studies are needed to clarify long-term oncological outcomes, cost-effectiveness, and the optimal integration of robotic platforms into standard colorectal surgical practice. Full article

Background/Objectives: Minimally invasive surgery benefits patients but places physical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study examined whether physical and psychological preparatory protocols (warm-ups) influence surgeon strain during RALS. Methods: Ten consultant surgeons from East Lancashire Hospitals NHS Trust (UK) participated in a preregistered, randomized study. Each performed RALS under three conditions: control, physical warm-up (10 min simulation tasks on the Da Vinci system), and psychological warm-up (10 min PETTLEP-based mental imagery). Electromyography (EMG) and electroencephalography (EEG) were recorded during key surgical phases. EMG data were normalized to maximal voluntary contractions. Results: The physical warm-up significantly increased EMG activity in the right deltoid and right trapezius (p < 0.05) compared to control, with no differences observed in other muscle groups. EEG alpha power data did not significantly differ between conditions. Conclusions: These findings suggest that brief physical warm-up can enhance muscle activation in key regions involved in RALS, potentially improving motor control and reducing fatigue. Incorporating such strategies may support surgeon performance and well-being. Full article

Background/Objectives: Iatrogenic nerve injury is a significant challenge in urologic surgery, with radical prostatectomy posing a high risk due to complex pelvic neural anatomy. Despite advances in robotic-assisted and nerve-sparing techniques, postoperative urinary incontinence and erectile dysfunction remain prevalent, adversely affecting patients’ quality of life and imposing substantial healthcare costs. Methods: A narrative review was conducted using PubMed, MEDLINE, and the Cochrane Library (searches through February 2026) for studies on radical prostatectomy epidemiology, mechanisms of nerve injury, functional outcomes, and economic burden. Emerging intraoperative fluorescence imaging technologies, surgical strategies to mitigate iatrogenic nerve injuries, and the financial costs of post-prostatectomy complications were assessed. Results: Robotic-assisted radical prostatectomy now accounts for >80% of procedures in the United States, and has been associated in observational studies with improved early recovery of erectile function compared with open and laparoscopic approaches. However, the lack of real-time nerve visualization remains a limiting factor. Recent milestones (January 2026) include the Food and Drug Administration Investigational New Drug clearance for the nerve-specific fluorophore LGW16-03 (NerveTrace), which enables real-time identification of sub-millimeter nerve branches, and the 510(k) premarket clearance of Dendrite imaging (November 2025). Conclusions: Enhanced intraoperative nerve discrimination via molecularly targeted imaging has the potential to reduce iatrogenic complications and improve long-term functional and economic outcomes in prostate cancer surgery, although these benefits have yet to be demonstrated in prospective clinical and health-economic studies. Full article

Apical pelvic organ prolapse (POP) is characterized by descent of the uterus or post-hysterectomy vaginal vault resulting from failure of level I pelvic support and represents a major contributor to pelvic floor dysfunction and recurrent prolapse surgery. Loss of apical support is frequently associated with anterior and posterior compartment defects, leading to vaginal bulge symptoms, pelvic pressure, urinary and bowel dysfunction, sexual dysfunction, and reduced quality of life. This narrative review summarizes current knowledge on POP, from molecular mechanisms and emerging biomarkers to contemporary surgical management, with particular emphasis on sacrocolpopexy and robotic-assisted approaches. A literature search of PubMed, Scopus, Google Scholar, and Consensus identified peer-reviewed studies published up to February 2026. Evidence demonstrates that POP has a multifactorial and polygenic background involving extracellular matrix remodeling, connective tissue integrity, smooth muscle dysfunction, and altered level of protein expression. Several candidate biomarkers, including single-nucleotide polymorphisms, circulating proteins, metabolites, and imaging-based parameters, show potential for risk prediction and earlier diagnosis, although routine clinical implementation remains limited. Sacrocolpopexy remains the gold standard for apical prolapse repair because of superior anatomical outcomes, low recurrence, and significant quality-of-life improvement. Laparoscopic and robotic-assisted sacrocolpopexy provide comparable efficacy with reduced blood loss, shorter hospitalization, and faster recovery. The objective success rate is usually over 90%. Complications are very rare and typically include mesh erosion in 2–4% of cases and the need for reoperation in 6% of cases. Our own experience shows that, for a group of surgeons, the learning curve for the laparoscopic approach reached a plateau after a total of 30 operations. Robotic platforms may facilitate complex pelvic dissection and shorten the learning curve, although higher procedural costs remain a major limitation. Full article

Background: Precise intraoperative localisation of small colorectal tumours during laparoscopic surgery remains challenging due to absent tactile feedback and subserosal tumour location. Current standard methods, particularly India ink tattooing, demonstrate 15–30% failure rates for lesions less than 10 mm, leading to prolonged operative times, incomplete resections, and re-operations. Multiple emerging technologies promise improved localisation, yet comparative evidence remains fragmented. Objective: To map and characterise the current landscape of intraoperative marking and identification technologies for small colorectal tumour localisation during laparoscopic surgery, with emphasis on radiofrequency-based methods and alternative approaches, and to identify evidence gaps guiding future research. Methods: Following PRISMA-ScR guidelines, we systematically searched PubMed, Web of Science, and Scopus databases from January 2000 through December 2025 for studies evaluating tumour localisation technologies in colorectal cancer surgery, including primary tumour localisation during laparoscopic colectomy and localisation of colorectal liver metastases during hepatic surgery, or transferable anatomical applications with documented translational potential to colorectal surgery. Two independent reviewers screened all records, with discrepancies resolved through discussion and a third senior reviewer consulted for unresolved disagreements; data were extracted on technical performance, safety, feasibility, cost-effectiveness, usability, innovation potential, and evidence quality. Results: We included 89 studies comprising 18 colorectal-specific articles and 71 transferable/GI-adjacent studies. Detection success rates ranged from 71% to 100% across modalities. Near-infrared fluorescence with indocyanine green demonstrated the strongest clinical evidence with 75–100% detection across eight colorectal studies encompassing 2134 procedures and seamless workflow integration. Radiofrequency identification systems achieved 91.9–99% detection in feasibility studies with promising tissue penetration of 15–35 mm but limited colorectal validation. Electromagnetic navigation excelled in rigid organs with 85–98% success but showed degraded performance in mobile bowel at 71–75%. Critical evidence gaps included absent head-to-head comparative trials, non-standardised outcome metrics limiting cross-study comparability, and limited long-term safety data with only 14 studies providing follow-up exceeding six months. Conclusions: ICG fluorescence represents the most clinically mature technology identified, representing a priority candidate for colorectal-specific validation in challenging localisation scenarios. RFID systems demonstrate promising characteristics justifying prioritised research investment through adequately powered comparative trials. Future research must emphasise consortium-based comparative effectiveness studies, standardised outcome metrics, and integration with robotic and AI-assisted surgical platforms to accelerate clinical translation. Full article

Objective: Minimally invasive surgery in Hirschsprung disease (HSCR) management was introduced in the mid-1990s. Despite decades of clinical application of various laparoscopic approaches, there remains a paucity of high-powered prospective studies and comprehensive systematic reviews in the literature. This study aimed to systematically review and summarize published techniques and outcomes of laparoscopic- and robotic-assisted surgery in HSCR. Methods: A systematic literature review was conducted using PubMed and the Cochrane Library. Studies reporting technical and outcome data of laparoscopic- or robotic-assisted surgery for HSCR were included. Data extraction and analysis were performed in accordance with the PRISMA 2020 guidelines. Parameters of interest included surgical technique, age at primary pull-through (PT), operative time, and functional outcomes. Outcomes of laparoscopic- versus robotic-assisted Yancey–Soave PT were compared. Results: A total of 700 publications were screened, of which seven studies met the inclusion criteria. Data from 556 patients were analyzed. A total of 338 underwent laparoscopic-assisted, and 218 underwent robotic-assisted pull-through. Large variability of the reported transanal resection technique (modified Yancey–Soave PT) was reported. Four studies reported functional outcomes in patients aged over four years. Three studies directly compared laparoscopic- and robotic-assisted PT; two reported no difference in the incidence of postoperative Hirschsprung-associated enterocolitis (HAEC). Functional outcomes were assessed using the Krickenbeck classification in three studies and the bowel function score in one study, with no significant differences reported in patients aged >4 years. Conclusions: Laparoscopic- and robotic-assisted Yancey–Soave PT appears to be safe for HSCR. Large variability in the applied surgical technique—despite being commonly classified as modified Yancey–Soave PT—as well as heterogeneity in the bowel function assessment, limit direct comparability between studies. To date, no single minimally invasive approach has demonstrated clear superiority over others. Prospective, randomized controlled studies are required to enable robust comparative evaluation of techniques, overall costs, and outcomes. Full article

Objective: The aim of this study was to evaluate the safety and efficacy of robot-assisted laparoscopic ureteroureterostomy (RALUU) and laparoscopic ureteroureterostomy (LUU) for duplicated kidney malformations in infants. Methods: This retrospective comparative cohort included infants with duplicated kidney malformations who underwent RALUU or LUU between May 2021 and April 2025. Perioperative variables assessed included operative duration, blood loss, oral feeding time, FLACC pain score, hospital stay, and complications. Follow-up outcomes included changes in anteroposterior pelvic diameter (APD), ureteral diameter (UD), and renal function (RF) of the affected upper moiety, assessed using renal ultrasonography and radionuclide imaging, with preoperative measurements serving as the baseline reference. The minimum follow-up duration was 12 months. Surgical success was determined based on fulfillment of all three criteria: resolution or alleviation of clinical symptoms, a reduction in APD and UD, and preserved or improved upper-moiety renal function compared with baseline. Results: The final cohort consisted of 52 infants (RALUU, n = 28; LUU, n = 24). Demographic and clinical profiles were comparable between groups. RALUU was associated with a shorter operative duration than LUU (139.6 ± 16.6 vs. 151.8 ± 21.6 min, p = 0.029). Estimated blood loss, time to oral feeding, FLACC pain score, and hospital stay were comparable. Postoperative complications were observed in 2 RALUU patients and 3 LUU patients. One patient in the LUU group developed urine leakage, which was managed conservatively. Postoperative urinary tract infection occurred in 2 patients in each group. No patient required secondary surgery. At a mean follow-up of 26.8 ± 10.4 and 28.1 ± 11.7 months in the RALUU and LUU groups, both groups showed significant reductions in APD and UD, with preserved RF and a modest postoperative increase. Conclusions: Both RALUU and LUU were safe and effective for duplicated kidney malformations in infants. RALUU was associated with a shorter operative time, while postoperative recovery, complication rates, and follow-up outcomes were comparable. Full article

Background/Objectives: Robot-assisted partial nephrectomy (RAPN) has increasingly replaced laparoscopic partial nephrectomy (LPN) in the management of localized renal tumours. This study aimed to evaluate perioperative, functional and surgical margin outcomes during an institutional transition from LPN to RAPN in a high-volume centre. Methods: We performed a retrospective single-centre analysis of 100 consecutive patients undergoing minimally invasive partial nephrectomy. The last 50 LPN cases (August 2014–May 2018) were compared with the first 50 RAPN cases (June 2018–February 2020). Baseline characteristics, perioperative outcomes, early functional parameters and surgical margin status were analysed. Complications were classified according to the Clavien–Dindo system. Results: Tumours treated in the RAPN group were significantly larger (3.4 vs. 2.5 cm) and more complex (RENAL score of 6 vs. 5; p < 0.001). Operative time was longer in the RAPN group (143 vs. 122 min; p < 0.01), while warm ischaemia time did not differ significantly (16 vs. 15 min; p = 0.37). Estimated blood loss was lower (0 vs. 10 mL; p = 0.049) and the hospital stay was shorter (3 vs. 4 days; p < 0.001) in the RAPN group. Haemoglobin decrease and postoperative creatinine change were comparable between groups. Positive surgical margins were observed less frequently in the RAPN group (2.3% vs. 7.7%), but this difference was not statistically significant (p = 0.34). Complication rates were significantly lower in the RAPN group (4% vs. 22%; p < 0.05), with no major complications observed in the robotic cohort. Conclusions: In this institutional experience, RAPN was associated with favourable perioperative outcomes during the transition period, despite the treatment of larger and more complex renal tumours. The slightly longer operative and warm ischaemia times likely reflect a more comprehensive reconstruction strategy, which may contribute to improved haemostatic control and lower complication rates. Further studies with extended follow-up are required to evaluate oncological and renal functional outcomes. Full article