Systematic Review of Current and Future Perspectives of Robotic Partial Nephrectomy

Background: Nephron-sparing surgery has become a standard approach for localized renal masses because it preserves renal function while providing oncologic control comparable with radical nephrectomy. Robot-assisted partial nephrectomy (RAPN) has expanded the minimally invasive management of increasingly complex renal tumors. This review summarizes contemporary clinical outcomes and emerging technologies in RAPN. Materials and Methods: A PRISMA-guided literature search was conducted in PubMed/MEDLINE and Scopus for peer-reviewed English-language human studies published between January 2020 and June 2025. Search terms included robot-assisted partial nephrectomy, robotic partial nephrectomy, RAPN, nephron-sparing surgery, single-port robotics, augmented reality, three-dimensional surgical planning, fluorescence-guided nephrectomy, and learning curve. Manual reference screening was also performed. Twenty eligible studies were included for qualitative synthesis; quantitative meta-analysis was not performed because of heterogeneity in study designs and endpoints. Results: Comparative randomized, propensity-matched, and multicenter studies generally showed faster postoperative recovery, less pain, and shorter hospitalization with RAPN than with open partial nephrectomy, while maintaining comparable oncologic outcomes. RAPN was feasible for hilar, endophytic, and solitary-kidney tumors in experienced centers. Three-dimensional planning and augmented-reality guidance improved anatomical visualization and operative planning, while indocyanine-green near-infrared fluorescence supported selective ischemia and perfusion assessment. Single-port RAPN demonstrated broadly comparable perioperative outcomes with multiport approaches, although early adoption may involve longer operative times. Structured learning-curve and training models were associated with progressive improvement in operative performance and complication rates. Conclusion: Current evidence supports RAPN as a safe and effective nephron-sparing approach across a broad range of renal tumor complexity. Artificial intelligence-assisted image guidance, fluorescence-based perfusion assessment, three-dimensional planning, and next-generation single-port platforms may further improve precision and functional preservation. Larger multicenter randomized studies and longer follow-up are needed to establish durable oncologic, functional, and cost-effectiveness benchmarks.