Ces Urol 2025, 29(4):217-222 | DOI: 10.48095/cccu2025028

Robot-assisted partial resection of multiple kidney tumors

Jana Kocháňová, Jiří Heráček, Miroslav Záleský

Urologická klinika 1. LF UK a ÚVN – VFN Praha

Major statement: The study evaluated robot-assisted partial nephrectomy in 18 patients with multiple ipsilateral renal tumors. The results showed that it is a safe procedure with a low rate of complications, positive margins, and recurrences, while effectively preserving renal function.

Summary: Introduction: Robot-assisted partial nephrectomy represents the standard nephron-sparing procedure for localized renal tumors. Multiple ipsilateral renal tumors are rare, and their surgical management poses a challenge in terms of preserving renal function and ensuring oncological safety. The aim of this study was to evaluate the safety, functional, and oncological outcomes of robot-assisted partial nephrectomy in patients with multiple renal tumors.

Methods: We retrospectively analyzed data from 18 patients who underwent robot-assisted partial nephrectomy for multiple ipsilateral renal tumors between 2008 and 2024. We assessed demographic characteristics, tumor morphology, surgical parameters (warm ischemia time, operative time, blood loss, type of clamping), complications according to the Clavien-Dindo classification, and renal function.

Results: A total of 38 tumors were resected. The mean warm ischemia time was 14 minutes, and did not exceed 25 minutes in any patient. Complications occurred in 11% of patients, all classified as grade II according to Clavien-Dindo. Positive surgical margins were observed in 2.6% of resected tumors. The trifecta outcome was achieved in 94% of patients, while the pentafecta could be evaluated in 50% of cases. In 28% of patients, we used intraoperative ultrasound to verify the tumor. To confirm the effect of clamping, we administered indocyanine green in 22% of patients. Tumor recurrence was observed in 5.5% of patients, and renal function preservation at 12 months was ≥ 90% in all evaluable patients.

Conclusion: Robot-assisted partial nephrectomy for multiple ipsilateral renal masses is a safe technique with a low complication rate and favorable oncological and functional outcomes. Advanced surgical techniques, including selective clamping and intraoperative ultrasound verification, allow for maximal preservation of renal parenchyma and contribute to optimizing the surgical procedure.

Keywords: indocyanine green – multiple renal tumors – robot-assisted partial nephrectomy – selective clamping – warm ischemia

Received: November 7, 2025; Revised: December 3, 2025; Accepted: December 4, 2025; Published: December 29, 2025