Robotic Partial Nephrectomy Is Associated with a Significantly Decreased Rate of Postoperative Pseudoaneurysm Compared to Open and Laparoscopic Partial Nephrectomy

Abstract Background: While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. Methods: This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012-2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Results: Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p=0.04). Only surgery length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p=0.53). Conclusions: RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p=0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. Limitations: This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-up is warranted. Patient Summary:This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.