Radical nephrectomy remains a primary treatment for renal cell carcinoma (RCC) when nephron-sparing surgery is not feasible. This
study compares robot-assisted and laparoscopic radical nephrectomy performed at East Surrey Hospital over a 7-year period, focusing on perioperative outcomes, complications, oncological safety, and treatment timelines.​

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A retrospective review of 113 patients (2018–2024) was conducted: 50 underwent robot-assisted and 63 underwent laparoscopic radical nephrectomy. Demographics, operative details, TNM staging, complication profiles (Clavien-Dindo classification), and timelines from diagnosis to surgery were analyzed. POSSUM risk scores and margin status were used to assess surgical risk and oncological outcomes.​

A total of 113 patients underwent radical nephrectomy between 2018 and 2024, including 50 robot-assisted and 63 laparoscopic cases. The mean age was 66.4 years in the robotic group and 64.8 years in the laparoscopic group. Mean eGFR was 69.04 and 73.86 mL/min/1.73m², respectively. Operative time was longer in robotic cases (238 vs 191 minutes), though blood loss and transfusion requirements were similar. Intraoperative complications occurred in 2 robotic cases and 4 laparoscopic cases, while postoperative complications were reported in 13 and 14 patients, respectively. Clavien-Dindo classification showed a comparable distribution of complication severity in both groups, with most complications being Grade I or II, requiring only conservative or pharmacological management. Margin positivity was slightly lower in the robotic group (2 vs 3), and robotic procedures were more frequently used for higher-stage tumors. The average time from diagnosis to surgery was 69 days, with some delays exceeding the NHS 62-day cancer pathway target. POSSUM scores predicted slightly higher morbidity and mortality in the robotic group, likely reflecting greater case complexity. Since its introduction in 2020, robotic nephrectomy has grown steadily, comprising 70% of all radical nephrectomies by 2024.​

Robot-assisted radical nephrectomy is a safe and effective surgical option for renal cell carcinoma, with outcomes comparable to laparoscopic nephrectomy. Our data suggest slightly fewer intraoperative complications and marginally improved margin negativity in the robotic group, a trend toward shorter hospital stay, although operative time was longer—likely due to more complex tumor profiles and setup requirements. Radical nephrectomy remains the standard of care for non-metastatic, unresectable renal tumors not suitable for nephron-sparing surgery. Despite higher POSSUM-predicted morbidity and mortality in robotic cases, actual outcomes, including ICU admissions and complications, were similar, supporting its use in higher-risk patients. This review supports the growing trend toward robotic surgery, driven by enhanced surgical precision, improved ergonomics, and institutional investment.​

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This review focused solely on radical nephrectomy; future evaluations should include partial nephrectomy and nephroureterectomy.​ Comparative national and international studies, including data from BAUS and SIU, reflect similar findings: robotic nephrectomy shows comparable oncological outcomes with slightly better recovery metrics and surgical precision.​ Evidence suggests robotic-assisted partial nephrectomy and nephroureterectomy are associated with lower blood loss, shorter hospital stays, and improved preservation of renal function compared to laparoscopic methods.​ Promote equitable robotic access across NHS and other healthcare systems.​ Continue prospective data collection and participate in multicentre audit initiatives for long-term outcomes.​
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Asimakopoulos et al., BMC Urology 2014 – Robotic radical nephrectomy: A systematic review.?
?  British Association of Urological Surgeons (BAUS) Surgical Outcomes Audits, 2020–2024.
SIU Congress Abstracts – Trends in minimally invasive urology, 2018–2023.?