Evaluating the Efficacy of Robot-Assisted Partial Nephrectomy in Complex Renal Tumours: A Single-Centre Retrospective Study

<i>Background and Objectives</i>: Robotic-assisted partial nephrectomy (RAPN) is a preferred minimally invasive option for renal tumours, but its use in highly complex cases (RENAL score ≥ 9) remains underexplored. Only four Asian countries, India, China, South Korea, and Japan, have published studies on RAPN for complex kidney tumours, highlighting limited evidence. The aim of this study is to assess the perioperative, functional, and oncological effects of RAPN for complex renal tumours at a single tertiary centre in Malaysia. <i>Materials and Methods</i>: Patient demographics, tumour characteristics, perioperative parameters, and postoperative results were collected through a retrospective review that was conducted on 35 patients who had undergone RAPN between January 2023 and June 2024. The outcomes were analyzed using descriptive statistics, correlation analysis, and comparative tests between surgical approaches (transperitoneal vs. retroperitoneal). <i>Results</i>: Of the 35 patients, all had high-complexity tumours. RAPN achieved a "trifecta" outcome in 88.6% of patients. Significantly lower intraoperative blood loss is associated with the retroperitoneal approach in comparison with the transperitoneal approach, whereas other perioperative parameters, which include warm ischaemia time, did not show any significant differences. No positive surgical margins were observed, and no local recurrences or port-site metastases were detected during a mean follow-up of 11.31 ± 5.78 months. Postoperative changes in renal function were negligible, with a mean creatinine change of 5.69 ± 20.39 µmol/L. <i>Conclusions</i>: RAPN is a safe and effective option for complex renal tumours, offering excellent functional and oncological outcomes. The choice between transperitoneal and retroperitoneal approaches should be tailored to tumour characteristics for optimal surgical outcomes. This single-centre Malaysian study contributes to the limited Southeast Asian literature on RAPN for complex renal tumours.