To update the comparative evidence on robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for patients with cT1-cT2 renal tumors, with emphasis on cancer control, perioperative recovery, and postoperative kidney function. Four databases were queried for English-language comparative studies published between January 30, 2016 and March 1, 2026. Eligible reports enrolled adults with localized renal tumors treated with RAPN or LPN and provided extractable oncological, perioperative, or renal functional data. Two reviewers performed study selection, extraction, and quality appraisal. Treatment effects were calculated as odds ratios for binary variables and mean differences for continuous variables. Heterogeneity, sensitivity, small-study effects, subgroup patterns, and evidence certainty were explored where data allowed. Twenty-two studies with 6,202 participants were analyzed. Surgical margin positivity and recurrence did not differ materially between RAPN and LPN (OR 0.83, 95% CI 0.49-1.42; and OR 1.32, 95% CI 0.43-4.02, respectively). RAPN was associated with fewer overall complications (OR 0.72, 95% CI 0.55-0.93), lower transfusion requirement (OR 0.49, 95% CI 0.25-0.94), less blood loss (MD -27.88 mL, 95% CI -40.28 to -15.47), shorter warm ischemia (MD -3.54 min, 95% CI -4.65 to -2.44), smaller eGFR reduction (MD -3.05 mL/min/1.73 m2, 95% CI -4.30 to -1.80), and reduced new-onset CKD (OR 0.61, 95% CI 0.42-0.88). However, the certainty of evidence was low or very low for all outcomes, and these findings should be interpreted as associations rather than proof of definitive superiority. In contemporary comparative studies, RAPN appeared oncologically comparable with LPN and was associated with favorable estimates for selected perioperative and renal functional outcomes. Because the certainty of evidence was low or very low, the clinical implications should be interpreted cautiously and may be most relevant for complex tumors and patients in whom renal preservation is particularly important.
Journal of robotic surgery. 2026 Jul 20*** epublish ***
Yucong Chai, Yinxiong Zhou, Yuqi Jiang, Junzhe Dai, Yumei Zeng, Jing Liu
School of Medicine, University of Electronic Science and Technology of China, Chengdu, China., Department of Urology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Qingyang District, Chengdu, 610072, China., Department of Nursing, The Fourth People's Hospital of Shifang, Shifang, 618400, Sichuan, China. ., Department of Urology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Qingyang District, Chengdu, 610072, China. .