Comparisons of Efficiency, Safety, and Hospital Costs of Four-Arm Robotic-Assisted Partial Nephrectomy (RAPN) Versus Three-Arm Technique: A Propensity Score–Matched Analysis

<b>Objectives</b>: The advent of robotic-assisted partial nephrectomy (RAPN) has marked a new era in minimally invasive surgery, establishing itself as a preferred method for managing renal cell carcinoma (RCC). However, even within the same center, variations in the use of robotic arms during RAPN have been reported. In this study, we aim to explore differences in efficiency, safety, and hospital costs between three-arm and four-arm RAPN. <b>Methods</b>: This retrospective study analyzed the clinical data of 91 patients who underwent RAPN in Tongji Hospital from January 2021 to December 2023. The patients were divided into two groups: 50 patients in the three-arm group (with the use of three robotic arms and two assistant ports) and 41 patients in the four-arm group (with the use of four robotic arms and one assistant port). Patients' demographics and tumor characteristics, operative outcomes, and hospital costs were recorded. Propensity score matching (1:1) was performed on age, gender, body mass index, laterality, RENAL score, tumor stage, and pathological grade. We compared three-arm with four-arm RAPN groups based on operative outcomes, and hospital costs. <b>Results</b>: In total, 50 and 41 patients underwent three-arm and four-arm RAPN. All procedures were successfully executed without the need to convert to open surgery or radical nephrectomy. After matching, the four-arm configuration demonstrated a numerically longer total operative time compared with the three-arm approach (146.5 vs. 120.0 min, <i>p</i> = 0.068). Hospital costs in the four-arm group were significantly higher than those in the three-arm group (76,922.5 vs. 68,406.7 CNY, <i>p</i> = 0.006). <b>Conclusions</b>: Both the three-arm and four-arm robotic approaches demonstrated comparable safety and efficacy in RAPN procedures. Nevertheless, the four-arm approach is associated with elevated hospital costs. The preliminary findings suggest potential cost containment disadvantages for the four-arm technique in selected cases, though larger multicenter studies are essential.