Safety, Feasibility and Prognostic Analysis of Surgical Treatment for High‐Complexity Renal Tumours (RENAL Score ≥ 10): A Summary of Experience With Robotic Technology Applications

OBJECTIVE: To compare the safety and feasibility of robot-assisted partial nephrectomy (RAPN) versus conventional laparoscopic surgery in patients with high-complexity renal tumours (RENAL score ≥ 10). METHODS: We retrospectively analysed 213 patients treated between March 2021 and May 2024. Patients underwent robot-assisted (n = 133) or laparoscopic (n = 80) surgery. Outcomes included partial nephrectomy rate, operative time, warm ischaemia time, estimated blood loss, postoperative complications, and length of hospital stay. RESULTS: Partial nephrectomy was achieved more frequently with RAPN than with laparoscopy (93.2% vs. 16.2%, p < 0.001). Tumours managed with partial nephrectomy were smaller than those requiring radical nephrectomy. No robotic cases required conversion to open surgery. Operative time was longer for RAPN, while warm ischaemia time and blood loss were comparable. RAPN was associated with shorter hospitalisation and fewer complications. A RENAL score ≥ 10 predicted radical nephrectomy only in the laparoscopic group. Tumour size correlated with operative time, blood loss, and warm ischaemia time. CONCLUSIONS: RAPN offers a higher nephron-sparing rate with comparable perioperative safety in high-complexity renal tumours. TRIAL REGISTRATION: This study was not a clinical trial. It was a retrospective, non-interventional observational analysis involving no prospective intervention, randomization, or experimental procedures; therefore, registration in a public clinical trial registry was not required in accordance with ICMJE recommendations.