Surgical Outcomes of Robotic versus Laparoscopic Unilateral Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Single-Center Retrospective Study

Surgical Outcomes of Robotic versus Laparoscopic Unilateral Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Single-Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical Outcomes of Robotic versus Laparoscopic Unilateral Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Single-Center Retrospective Study Xinji Yang, Qiming Zhang, Herong Zhu, Weilong Shi, Shudong Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8140158/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Purpose Laparoscopic unilateral nephrectomy has long been the standard minimally invasive procedure for native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD). With the evolution of the da Vinci Surgical System, robotic nephrectomy (RN) is increasingly adopted and offers potential advantages. However, comparative data between laparoscopic nephrectomy (LN) and RN remain limited. This study compares the perioperative outcomes of LN and RN in ADPKD patients undergoing unilateral nephrectomy. Methods We retrospectively reviewed ADPKD patients who underwent LN or RN at our center between February 2019 and September 2025. Patient characteristics, perioperative factors, kidney size, and complication rates were compared. Results In summary, ten cases were included in the RNx, and sixteen cases were included in the LNx. There was no significant difference in most of the parameters, but patients who have undergone kidney transplantation are more inclined to choose robotic nephrectomy (70% vs 18.8%, P=0.01). The RNx demonstrated significantly greater utilization of the preperitoneal approach (70% vs 12.5%, p=0.005). And a forest plot highlights significant differences in surgical outcomes between RNx and LNx groups, with RNx associated with less estimated blood loss (Cohen's d = -0.6) and a shorter diet recovery time (Cohen's d = -0.4). Conclusion These findings suggest that robotic unilateral nephrectomy was preferred by patients with a history of kidney transplantation and utilized the preperitoneal approach more frequently. Notably, RNx was associated with reduced blood loss and quicker diet recovery, suggesting potential benefits in postoperative outcomes. Polycystic Kidney Disease Robotic Surgery Nephrectomy Surgical Outcomes Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction ADPKD is a leading cause of end-stage renal disease (ESRD) in adults, characterized by progressive development of fluid-filled cysts that replace renal parenchyma and lead to renal functional decline. By age 70, up to 75% of ADPKD patients progress to ESRD, making it the most common hereditary form of adult polycystic kidney disease 1 . Genetically, ADPKD results from mutations primarily in the PKD1 gene on chromosome 16 (85% of cases) or the PKD2 gene on chromosome 4 (15%) 2 . The PKD1 locus is situated on the short arm of chromosome 16, closely linked to the α-globin gene cluster 3 . Globally, ADPKD affects approximately 12.5 million individuals, with an estimated prevalence in the European Union of 3.5 per 10,000 people based on screening studies 4 . Clinical manifestations include pain and abdominal discomfort due to massive kidney enlargement, risks of progressive renal failure, and an increased incidence of renal cell carcinoma. These factors underscore the importance of timely diagnosis and proactive management. Historically, open nephrectomy (ON) was the primary surgical intervention for native kidney removal in ADPKD, but it is associated with substantial morbidity 5 . The shift towards minimally invasive surgery has popularized laparoscopic and robotic techniques. Prior studies indicate that LN offers superior outcomes compared to ON, including reduced morbidity, shorter hospital stays, and less postoperative pain 6 , 7 . Nowadays, the robotic platform enhances native nephrectomy for ADPKD through high-definition three-dimensional visualization and articulating instruments, facilitating complex surgical maneuvers 8 . While limited studies have compared RN and LN, no study has directly compared them specifically in the ADPKD population. This study compares patient characteristics and perioperative outcomes between RNx and LNx in ADPKD patients, with a brief description of a dual-position retroperitoneal approach for RNx. Methods This retrospective study was approved by the Institutional Review Board of our center, reviewed patients with ADPKD who underwent RN or LN between February 2019 and September 2025. Relevant data were collected, including patient characteristics, indication for surgery, bilateral kidney size, surgical kidney size, peri-operative details, pathology and complication rates. Preoperative cross-sectional imaging was available for all patients. Kidney size was assessed by the largest craniocaudal dimension on preoperative computed tomography (CT), and ellipsoid volume was calculated from length, width, and height measurements. All RN procedures were performed by a single surgeon with extensive robotic surgery experience; a case report was also included to illustrate the dual-position retroperitoneal technique for RNx. SPSS 27.0 was used to calculate p-values for examining the significance of these parameters between the two groups. Due to the relatively small sample size, RStudio and R 4.5.1 were employed to compute Cohen's d (negligible effect: |d| < 0.2; small effect: 0.2 ≤ |d| < 0.5; medium effect: 0.5 ≤ |d| < 0.8; large effect: |d| ≥ 0.8) for continuous variables and Cramer's V (negligible association: V<0.1; weak association: 0.1<V<0.3; moderate association: 0.3<V0.5) for categorical variables related to surgical parameters. This approach was adopted to better demonstrate differences between parameters and present effect sizes for surgical outcomes. Results Patient Characteristics, Indication for Surgery and Bilateral Kidney Size Within the specified time frame, ten cases were included in the RNx, and sixteen cases were included in the LNx. The median age was 59 years (IQR 51.75–60.25) in the RNx and 49.5 years (IQR 41–59.5) in the LNx (p = 0.15). The RNx had a higher proportion of females (50% vs. 31.3%), a higher median BMI (22.7 vs. 22.35) compared to the LNx; these differences were not statistically significant (p = 0.29, p = 0.47, respectively). Hypertension was present in 8 cases (80%) in the RNx and 13 cases (81.3%) in the LNx (p = 0.66). A history of kidney transplantation was more common in the RNx (70% vs. 18.8%, p = 0.01). The most frequent indication for nephrectomy in the RNx was symptom burden (70%), whereas recurrent pyelonephritis was the leading indication in the LNx (43.8%). Reported symptoms included flank pain, abdominal pain, early satiety, cyst infection, hematuria, dyspnea, and limited mobility. The median largest dimension of the right kidney was 19.3 cm in the RNx and 20.5 cm in the LNx (p = 0.93). The median largest dimension of the left kidney was 21.6 cm in both groups (p = 0.34). The median left kidney volume was 1991 cm³ for RNx and 2344 cm³ for LNx (p = 0.26), while the median right kidney volume was 1496 cm³ for RNx and 2128 cm³ for LNx (p = 0.72). (Table 1) Perioperative Data In the RNx, 6 cases (60%) underwent left nephrectomy, compared with 9 cases (56.3%) in the LNx (p = 0.59). A dual-position retroperitoneal approach was used in 3 cases (30%) in the RNx, whereas 14 cases (87.5%) in the LNx underwent a single-position retroperitoneal approach (p = 0.005). The median American Society of Anesthesiologists (ASA) physical status was grade II in both groups. The surgical kidneys had comparable sizes between the groups, with a median largest dimension of 20 cm (IQR 16.5–22.4) in the RNx and 21.6 cm (IQR 18–25.9) in the LNx (p = 0.29). And the median volume of the surgical ellipsoid kidney was 1552 cm 3 (IQR 1107.1–2428.2) in the RNx and 2240 cm 3 (IQR 1772.2–3352.9) in the LNx (p = 0.14). No significant difference was observed in the median operation time, the median estimated blood loss (EBL), the median hospital stay time, the median diet recovery time between the groups (176 minutes vs 191 minutes, p = 0.29; 50 mL vs 100 mL, p = 0.17; 9.5 days vs 11.5 days, p = 0.37; 2 days vs 2.5 days, p = 0.28). In the RNx, none of the cases required preoperative nasogastric tube placement; whereas in the LNx, two cases needed preoperative nasogastric tube placement (0 vs 12.5%, p = 0.37). In the RNx, three cases required transfer to the ICU for advanced life support postoperatively, whereas in the LNx, four cases needed ICU transfer for advanced life support (30% vs 25%, p = 0.78). (Table 2) Postoperative Complications and Pathology The overall incidence of at least one postoperative complication was comparable between the two groups, occurring in 6 cases (60%) in the RNx and 10 cases (62.5%) in the LNx (p = 0.61). Blood transfusion was required in one case (10%) in the RNx, compared with four cases (25%) in the LNx (p = 0.34). No instances of arteriovenous fistula closure, delayed wound healing, or lymphatic leak were observed in the RNx. In contrast, one case (6.3%) in the LNx developed arteriovenous fistula closure, one case (6.3%) developed lymphatic leak, and one case (6.3%) experienced delayed wound healing. One RNx case (10%) had a mild intestinal obstruction, a complication not seen in the LNx. Postoperative fever lasting more than 3 days was reported in 4 cases (40%) in the RNx and 10 cases (62.5%) in the LNx (p = 0.24). Postoperative mental status change was noted in 2 cases (20%) in the RNx and 1 case (6.3%) in the LNx (p = 0.32). In the LNx, one case (6.3%) was readmitted within 30 days postoperatively due to a lymphatic leak. No patients in the RNx required readmission for postoperative complications. Postoperative pathological examination confirmed benign disease in 9 cases (90%) in the RNx and 14 cases (87.5%) in the LNx (p = 0.68). (Table 3) Analysis of the Forest Plot Results Based on the Cramer’s V values only mild intestinal obstruction (Cramer’s V=0.253, weak-to-moderate association) emerges as a potentially noteworthy postoperative signal, while all other categorical variables lie below the 0.23 threshold and convey little independent predictive information ( Fig. 1 ) ; meanwhile Cohen’s d shows that the between-group difference in blood loss (Cohen’s d≈-0.6, medium effect) is the sole clearly meaningful disparity, with diet recovery time displaying a small effect (Cohen’s d≈-0.4) and both operation time and hospital stay time exhibiting negligible effects (Cohen’s d ≈ 0; Cohen’s d≈-0.2) ( Fig. 2 ) . Dual-Position Retroperitoneal Approach We present a brief description of a dual-position retroperitoneal approach for RNx: A 61-year-old female was admitted on June 25, 2025, with a history of ADPKD over 20 years, aggravated by dyspnea orthopnea, bilateral lower limb edema, and abdominal distension for more than 3 months. Elevated serum creatinine (peaking at 1032 µmol/L) prompted initiation of regular hemodialysis 8 years ago. Imaging revealed a right kidney measuring 3158cm 3 and a left kidney measuring 2681cm 3 ( Fig. 3 A, 3 B ). Cardiomegaly was also noted ( Fig. 3 C ) . The patient's symptoms were attributed to compression of the thoracic and abdominal cavities by the massively enlarged polycystic kidneys. A robot-assisted left nephrectomy via a dual-position retroperitoneal approach was planned. The patient was placed in the right lateral decubitus position, and the kidney bridge was elevated to 150° to increase the left costocliac space ( Fig. 4 A ) . The initial Trocar layout is shown in the figure below ( Fig. 4 B ) . The lateroconal fascia was fanned out and dissected caudally, fully exposing it beneath the extraperitoneal fat. The ureter was dissected along the psoas major muscle. Approaching the renal pedicle revealed severe tissue adhesion. The left renal artery was identified, ligated with a single polymer clip, and transected ( Fig. 5 A ) . Subsequently, the left renal vein and its tributaries were gradually exposed, ligated with polymer clips, and transected ( Fig. 5 B ) . The kidney was mobilized circumferentially. The ureter was clipped and transected ( Fig. 5 C ) . During dissection of the lower pole, the large volume of the polycystic kidney and insufficient working space for the robotic arms prevented complete mobilization. Consequently, the configuration of the trocars was adjusted ( Fig. 4 C ) . This revised configuration allowed for complete mobilization of the kidney. The total operation time was 163 minutes, with an estimated blood loss of 50 mL. The patient was discharged on postoperative day 5. At the one-week follow-up, the patient reported significant improvement in abdominal distension and shortness of breath, indicating a successful surgical outcome. Discussion The large volume of polycystic kidneys results in limited operating space and difficult exposure of renal anatomical structures. Due to displacement of abdominal organs caused by compression from polycystic kidneys, the anatomical architecture becomes unclear, increasing the risk of collateral injury during surgery and potential damage to arteries and veins, which may lead to massive hemorrhage. Rupture of renal cysts in polycystic kidneys can cause abdominal infection, subsequently raising the likelihood of postoperative fever and septic shock. Most patients also suffer from renal failure, contributing to elevated perioperative and anesthetic risks. These factors collectively increase the complexity of polycystic kidney nephrectomy, placing significant demands on the surgeon's anatomical knowledge and surgical experience. And native nephrectomy is indicated in patients with the following manifestations: 1.Markedly enlarged kidneys that compromise future space for renal allograft placement; 2.Recurrent cyst infection or hemorrhage; 3.Symptomatic nephrolithiasis; 4.Chronic pain; 5.Mass effect-related symptoms (early satiety, recurrent vomiting, dyspnea); 6.Suspected secondary malignant transformation 6 . Although traditionally performed via an open approach, associated with high morbidity, laparoscopic techniques have gained popularity. However, the minimally invasive approache can be technically challenging. The robotic platform combines the benefits of minimally invasive surgery with enhanced dexterity and a superior range of motion compared to conventional laparoscopy 9 . Therefore, performing a unilateral polycystic nephrectomy robotically may be the preferable option. Our analysis revealed a significant disparity in the preferred surgical approach: the robotic nephrectomy (RNx) group predominantly adopted the preperitoneal approach (70%), whereas the laparoscopic nephrectomy (LNx) group mainly utilized the single-position retroperitoneal approach (87.5%) (p = 0.005). This suggests that the robotic system may be better suited for handling massive polycystic kidneys within the more capacious peritoneal cavity, where its three-dimensional magnified vision and wristed instruments facilitate precise dissection between the cyst-laden kidney and adjacent organs. The preperitoneal approach is favored by many urologists due to the larger working space and familiarity with the anatomy. In contrast, the retroperitoneal approach avoids contact with abdominal organs and theoretically minimizes bowel interference, potentially reducing the risk of postoperative intestinal obstruction. It also offers other theoretical advantages, including avoidance of bowel mobilization, direct access to renal hilar structures, and potential reductions in operative time, blood loss, postoperative complications, and hospital stay, without compromising surgical outcomes 10 – 12 . In the RNx group, Cramer’s V for the incidence of postoperative mild intestinal obstruction was 0.253. Combined with prior data analysis, this suggests that RNx may be associated with a higher incidence of mild postoperative bowel obstruction. However, it should be noted that the number of preperitoneal procedures in the RNx was substantially higher than in the LNx. Therefore, the observed difference in postoperative bowel obstruction may be attributable to the choice of surgical approach rather than the surgical platform itself. Notably, based on Cohen’s d values and the corresponding forest plot ( Fig. 2 ) , RNx was also associated with a shorter time to diet recovery. It is important to highlight that RNx predominantly employed the preperitoneal approach, which can influence postoperative bowel function recovery. Importantly, even under these conditions, the robotic approach was still linked to a faster resumption of oral intake, further supporting its potentially beneficial role in preserving gastrointestinal function. Although the robotic retroperitoneal approach can make controlling the renal hilum challenging due to the confined working space for very large polycystic kidneys. In this series, the dual-position retroperitoneal technique was successfully implemented in three robotic cases. By intraoperatively adjusting the patient's position and trocar configuration, this technique expands the retroperitoneal working space. Thus, for patients with kidneys too massive for conventional retroperitoneal laparoscopic nephrectomy, the robotic dual-position retroperitoneal approach represents a valuable alternative. Notably, a significantly higher proportion of patients in the RNx had a history of kidney transplantation (70% vs. 18.8%, p = 0.01). For these patients, preserving transplanted kidney function is paramount. The robotic platform, with its enhanced precision and maneuverability, allows for more controlled dissection, potentially reducing the risk of inadvertent injury to adjacent structures, including the pelvic transplanted kidney, thereby offering a potential advantage in safeguarding graft function. Additionally, our findings indicate that the RNx group is strongly associated with reduced intraoperative blood loss. However, according to the studies by T 13 et al. and Crocerossa 11 et al., there was no significant difference in blood loss between laparoscopic and robot-assisted nephrectomy during radical nephrectomy, which contradicts our findings. Regarding these discrepancies, we propose several possible explanations. First, in terms of the study population, our research focused on patients undergoing nephrectomy for ADPKD. These patients typically present with massively enlarged kidneys and limited surgical space. In contrast, the aforementioned studies primarily enrolled renal cell carcinoma patients undergoing radical nephrectomy. This divergence in disease spectrum may lead to different responses to robotic-assisted surgery. Second, since ADPKD kidneys are filled with numerous cysts, the inevitable intraoperative rupture of these cysts and subsequent cyst fluid leakage may compromise the surgeon's accurate assessment of blood loss. However, overall, the significance of this discrepancy cannot be overlooked and warrants further validation in large-scale studies. However, this study has several limitations that should be considered when interpreting the results. First, its retrospective design and single-center nature may introduce selection bias and limit the generalizability of the findings. Institutional preferences in surgical approach and perioperative management could influence outcomes. Second, the relatively small sample size, particularly in the robotic cohort, reduces statistical power and may account for the lack of significant differences in many perioperative metrics, despite observable trends favoring the robotic approach. Finally, all robotic procedures were performed by a single highly experienced surgeon, which may further restrict the broader applicability of our technical observations. Therefore, future multi-institutional, prospective studies with larger patient cohorts are necessary to validate these preliminary findings and better elucidate the potential advantages of robotic-assisted nephrectomy in patients with ADPKD. Conclusion Robotic-assisted nephrectomy presents itself as a preferable and advanced surgical option for managing the complexities of ADPKD. It demonstrates potential superior outcomes, including reduced intraoperative blood loss and faster recovery of diet, which may be attributed to the platform's enhanced dexterity, magnified 3D vision, and superior maneuverability. These features are especially beneficial for dissecting massively enlarged, cyst-laden kidneys within the peritoneal cavity and for minimizing the risk of injury to a pelvic transplanted kidney, a critical consideration for a significant subset of patients. The choice of surgical approach is a key determinant of procedural outcomes, with the robotic platform offering flexibility, including the innovative dual-position retroperitoneal technique for challenging cases. However, the observed association with postoperative bowel obstruction appears to be more related to the preperitoneal approach than the robotic technology itself. Despite the encouraging results, the limitations of this study, including its retrospective design and small sample size, necessitate a cautious interpretation. Future prospective, multi-institutional studies with larger cohorts are essential to definitively establish the role and benefits of robotic-assisted nephrectomy in the ADPKD population. Declarations ACKNOWLEDGMENT The authors thank the staff of the Department of Urology, Peking University Third Hospital. FUNDING This research is supported by Wu Jieping Medical Foundation (320.6750.2022-03-45). DISCLOSURES Xinji Yang, Qiming Zhang, Herong Zhu, Weilong Shi, Shudong Zhang, Xiaofei Hou declare they have no conficts of interests that may be relevant to the contents of this study. ETHICAL APPROVAL All patients provided informed consent and the study protocol was approved by the institute’s Committee on Human Research. This study protocol was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee, and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. References Bergmann, C. et al. Polycystic kidney disease. Nat. Rev., Dis. Primers 4 , 50 (2018). Willey, C. J. et al. Prevalence of autosomal dominant polycystic kidney disease in the european union. Nephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc. 32 , 1356–1363 (2017). Reeders, S. T. et al. A highly polymorphic DNA marker linked to adult polycystic kidney disease on chromosome 16. Nature 317 , 542–544 (1985). New treatment paradigms for ADPKD: moving towards precision medicine - PubMed. https://pubmed.ncbi.nlm.nih.gov/28989174/. Colbert, G. B., Elrggal, M. E., Gaur, L. & Lerma, E. V. Update and review of adult polycystic kidney disease. Dis.-a-mon.: DM 66 , 100887 (2020). Neeff, H. P. et al. One hundred consecutive kidney transplantations with simultaneous ipsilateral nephrectomy in patients with autosomal dominant polycystic kidney disease. Nephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc. 28 , 466–471 (2013). Spithoven, E. M. et al. Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe: prevalence and survival--an analysis of data from the ERA-EDTA registry. Nephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc. 29 Suppl 4 , iv15-25 (2014). Jung, Y. et al. Volume regression of native polycystic kidneys after renal transplantation. Nephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc. 31 , 73–79 (2016). Binsaleh, S., Luke, P. P., Nguan, C. & Kapoor, A. Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique. Can. J. Urol. 13 , 3340–3345 (2006). S, A. et al. Retroperitoneal vs transperitoneal robot-assisted partial nephrectomy: comparison in a multi-institutional setting. Pubmed https://pubmed.ncbi.nlm.nih.gov/30053396/. N, S., P, B., G, S. & Gr, C. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis. Pubmed https://pubmed.ncbi.nlm.nih.gov/38358565/ (2024). A, H.-H. et al. Robot-assisted partial nephrectomy: a comparison of the transperitoneal and retroperitoneal approaches. Pubmed https://pubmed.ncbi.nlm.nih.gov/23461381/. T, U. et al. Robot-assisted radical nephrectomy in comparison with open and laparoscopic approaches: a japanese single-institution retrospective study. Pubmed https://pubmed.ncbi.nlm.nih.gov/41182417/ (2025). Tables Table.1 Patient Characteristic, Indication for Surgery and Bilateral Kidney Size Robotic Nephrectomy （n=10） Laparoscopic Nephrectomy（n=16） p -value Patient Characteristics Female (n, %) 5（50%） 5（31.3%） 0.29 Age (med, IQR) 59 (51.8-60.3) 49.5 (41-59.5) 0.15 BMI (med, IQR) 22.7（18.7-24.4） 22.35 (20.4-24.6) 0.47 Hypertension (n, %) 8（80%） 13（81.3%） 0.66 Post-Renal Transplant (n, %) 7（70%） 3（18.8%） 0.01* Indication for Surgery To Create Space for Transplant (n, %) 0 2（12.5%） 0.25 Symptomatic (n, %) 7（70%） 5（31.2%） 0.72 Concern for RCC (n, %) 2（20%） 2（12.5%） 0.61 Recurrent Pyelonephritis (n, %) 1（10%） 7（43.8%） 0.54 Largest Kidney Dimension on Preoperative CT (cm) Right Kidney (range) 11.1-25.5 13.8-32.8 Right Kidney (med, IQR) 19.3（16.3-22.3） 20.5（17.8-23.2） 0.93 Left Kidney (range) 15.9-26.9 12.6-33.4 Left Kidney (med, IQR) 21.6（17.8-22.4） 21.6（18.4-26.2） 0.34 Ellipsoid kidney volume (cm3) Right Kidney (range) 801-4764 566-5069 Right Kidney (med, IQR) 1496（978-2386） 2128（1371-2707） 0.72 Left Kidney (range) 845-5042 481-6219 Left Kidney (med, IQR) 1991（1349-2476） 2344（1797-3181） 0.26 Table.2 Perioperative Data Robotic Nephrectomy（n=10） Laparoscopic Nephrectomy（n=16） p -value Surgical Strategy Left Nephrectomy (n, %) 6 (60%） 9 (56.3%） 0.59 Retroperitoneal Approach (n, %) 3 (30%) (dual-position) 14 (87.5%) (single-position) 0.005* ASA Physical Status Classification Ⅱ (Ⅱ-Ⅲ） Ⅱ (Ⅱ-Ⅲ) Largest Dimension of the Surgical Ellipsoid Kidney (cm) Surgical Kidney (range) 15.8-26.9 12.6-33.4 Surgical Kidney (med, IQR) 20（16.5-22.4） 21.6（18-25.9） 0.29 Volume of the Surgical Ellipsoid Kidney (cm3) Surgical Kidney (range) 965.8-5042.3 480.9-6219.1 Surgical Kidney (med, IQR) 1552 (1107.1-2428.2) 2240 (1772.2-3352.9) 0.14 Peri-operative Details Operation Time (minutes) (med, IQR) 176（154.5-187.3） 191(158.8-213.3) 0.29 Estimated Blood Loss (mL) (med, IQR) 50（30-100） 100 (50-100) 0.17 Hospital Stay Time (days) (med, IQR) 9.5（7.5-12.8） 11.5（8.5-13.5） 0.37 ICU Admission (n, %) 3 (30%) 4 (25%) 0.78 Nasogastric Tube (n, %) 0 2（12.5%） 0.37 Time to Diet Resumption (days) (med, IQR) 2(2-3.3) 2.5(2-4) 0.28 Table.3 Postoperative Complications and Pathology Robotic Nephrectomy（n=10） Laparoscopic Nephrectomy（n=16） p -value Complications Any (n, %) 6 (60%) 10(62.5%) 0.61 Blood Transfusion (n, %) 1（10%） 4 (25%) 0.34 A-V Fistula Closure (n, %) 0 1（6.3%） 0.61 Delayed Wound Healing (n, %) 0 1（6.3%） 0.61 Lymphatic Leak (n, %) 0 1（6.3%） 0.61 Mild Intestinal Obstruction (n, %) 1 (10%) 0 0.39 Postop Fever >3 days (Sepsis) (n, %) 4 (40%) 10 (62.5%) 0.24 Postop Mental Status Change (n, %) 2 (20%) 1（6.3%） 0.32 30-day Readmission (n, %) 0 1（6.3%） 0.61 Pathology Benign (n, %) 9（90%） 14（87.5%） 0.68 Malignant (n, %) 1（10%） 2（12.5%） Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 19 Apr, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers invited by journal 03 Dec, 2025 Editor assigned by journal 19 Nov, 2025 Submission checks completed at journal 19 Nov, 2025 First submitted to journal 17 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8140158","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554440043,"identity":"94ae0402-fdee-4aa0-9c38-e6a86d18a2a1","order_by":0,"name":"Xinji Yang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xinji","middleName":"","lastName":"Yang","suffix":""},{"id":554440044,"identity":"c02afdb8-3083-40a8-aa3d-09af46444fdb","order_by":1,"name":"Qiming Zhang","email":"","orcid":"","institution":"Peking University Third 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02:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8140158/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8140158/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97673854,"identity":"366de465-dd18-41c9-9dac-084ee40a22a0","added_by":"auto","created_at":"2025-12-08 09:41:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1038987,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscriptfile3.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/be67ba5edef6ac986b686e0f.docx"},{"id":97656696,"identity":"c576d40d-0cc4-4e4e-8c15-6f83cda49713","added_by":"auto","created_at":"2025-12-08 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07:13:19","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65239,"visible":true,"origin":"","legend":"","description":"","filename":"a2013a71c1c846d7a3402bb12f65fa631structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/4d36a909ce7a2f7321ab05e8.xml"},{"id":97674734,"identity":"0c2afd48-fd48-4e7c-884e-0df10423fa98","added_by":"auto","created_at":"2025-12-08 09:44:00","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":71810,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/d05e5948fcc21ffc0df9739f.html"},{"id":97656695,"identity":"d7995e22-43ec-4951-94fc-f2d47c80d333","added_by":"auto","created_at":"2025-12-08 07:13:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76699,"visible":true,"origin":"","legend":"\u003cp\u003eThe forest plot shows Cramer's V for categorical variables related to surgical parameters (negligible association: V＜0.1; weak association: 0.1＜V＜0.3; moderate association: 0.3＜V＜0.5; strong association: V＞0.5)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/0bd7eaebef82fd2720741ebe.png"},{"id":97656694,"identity":"358c3f83-81dc-44ca-a87f-d1b08210b237","added_by":"auto","created_at":"2025-12-08 07:13:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31867,"visible":true,"origin":"","legend":"\u003cp\u003eThe forest plot shows Cohen's d for continuous variables related to surgical parameters (negligible effect: |d| \u0026lt; 0.2; small effect: 0.2 ≤ |d| \u0026lt; 0.5; medium effect: 0.5 ≤ |d| \u0026lt; 0.8; large effect: |d| ≥ 0.8)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/e377b7e1fb376521f97485e1.png"},{"id":97656699,"identity":"d5cd139c-a3b4-4f90-8a26-66a7736ee469","added_by":"auto","created_at":"2025-12-08 07:13:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":153795,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePreoperative imaging findings.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3A:\u003c/strong\u003ePreoperative MRU (axial view) demonstrates bilateral giant polycystic kidneys. \u003cstrong\u003e3B: \u003c/strong\u003ePreoperative MRU (coronal view) demonstrates bilateral giant polycystic kidneys. \u003cstrong\u003e3C:\u003c/strong\u003e Preoperative chest X-ray shows cardiomegaly (globular heart).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/97d1252dbd70897c6737973a.png"},{"id":97656702,"identity":"080fc291-261f-4fb9-a98b-198854eb61d9","added_by":"auto","created_at":"2025-12-08 07:13:19","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":279119,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient positioning and trocar placement.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4A:\u003c/strong\u003e The patient in the standard right lateral decubitus position with an elevated kidney bridge. \u003cstrong\u003e4B: \u003c/strong\u003eInitial configuration of trocar placement. \u003cstrong\u003e4C:\u003c/strong\u003eIntraoperative adjustment of the trocar configuration.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/96a510f7b05a4864a5d1db96.png"},{"id":97656703,"identity":"d37f7035-9536-4db3-ad91-53062dae4690","added_by":"auto","created_at":"2025-12-08 07:13:19","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":316849,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKey Intraoperative Steps Under Robotic View.\u003c/strong\u003e\u003cbr\u003e\n \u003cstrong\u003e5A:\u003c/strong\u003e Clipping and transection of the left renal artery of the polycystic kidney. \u003cstrong\u003e5B:\u003c/strong\u003e Clipping and transection of the left renal vein of the polycystic kidney. \u003cstrong\u003e5C: \u003c/strong\u003eClipping and transection of the left ureter of the polycystic kidney.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/a7ea1f4517e38193967afcd1.png"},{"id":98622267,"identity":"10ddfced-5422-49a1-ad50-9594dc0863cd","added_by":"auto","created_at":"2025-12-19 16:50:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1999830,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8140158/v1/e7ca44c4-11e3-4ab6-8e64-5e0d40d346dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical Outcomes of Robotic versus Laparoscopic Unilateral Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Single-Center Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eADPKD is a leading cause of end-stage renal disease (ESRD) in adults, characterized by progressive development of fluid-filled cysts that replace renal parenchyma and lead to renal functional decline. By age 70, up to 75% of ADPKD patients progress to ESRD, making it the most common hereditary form of adult polycystic kidney disease\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Genetically, ADPKD results from mutations primarily in the PKD1 gene on chromosome 16 (85% of cases) or the PKD2 gene on chromosome 4 (15%)\u003csup\u003e2\u003c/sup\u003e. The PKD1 locus is situated on the short arm of chromosome 16, closely linked to the α-globin gene cluster\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Globally, ADPKD affects approximately 12.5\u0026nbsp;million individuals, with an estimated prevalence in the European Union of 3.5 per 10,000 people based on screening studies\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Clinical manifestations include pain and abdominal discomfort due to massive kidney enlargement, risks of progressive renal failure, and an increased incidence of renal cell carcinoma. These factors underscore the importance of timely diagnosis and proactive management. Historically, open nephrectomy (ON) was the primary surgical intervention for native kidney removal in ADPKD, but it is associated with substantial morbidity\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The shift towards minimally invasive surgery has popularized laparoscopic and robotic techniques. Prior studies indicate that LN offers superior outcomes compared to ON, including reduced morbidity, shorter hospital stays, and less postoperative pain\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Nowadays, the robotic platform enhances native nephrectomy for ADPKD through high-definition three-dimensional visualization and articulating instruments, facilitating complex surgical maneuvers\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. While limited studies have compared RN and LN, no study has directly compared them specifically in the ADPKD population. This study compares patient characteristics and perioperative outcomes between RNx and LNx in ADPKD patients, with a brief description of a dual-position retroperitoneal approach for RNx.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective study was approved by the Institutional Review Board of our center, reviewed patients with ADPKD who underwent RN or LN between February 2019 and September 2025. Relevant data were collected, including patient characteristics, indication for surgery, bilateral kidney size, surgical kidney size, peri-operative details, pathology and complication rates. Preoperative cross-sectional imaging was available for all patients. Kidney size was assessed by the largest craniocaudal dimension on preoperative computed tomography (CT), and ellipsoid volume was calculated from length, width, and height measurements. All RN procedures were performed by a single surgeon with extensive robotic surgery experience; a case report was also included to illustrate the dual-position retroperitoneal technique for RNx. SPSS 27.0 was used to calculate p-values for examining the significance of these parameters between the two groups. Due to the relatively small sample size, RStudio and R 4.5.1 were employed to compute Cohen's d (negligible effect: |d| \u0026lt; 0.2; small effect: 0.2 \u0026le; |d| \u0026lt; 0.5; medium effect: 0.5 \u0026le; |d| \u0026lt; 0.8; large effect: |d| \u0026ge; 0.8) for continuous variables and Cramer's V (negligible association: V\u0026lt;0.1; weak association: 0.1\u0026lt;V\u0026lt;0.3; moderate association: 0.3\u0026lt;V\u0026lt;0.5; strong association: V\u0026gt;0.5) for categorical variables related to surgical parameters. This approach was adopted to better demonstrate differences between parameters and present effect sizes for surgical outcomes.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003ePatient Characteristics, Indication for Surgery and Bilateral Kidney Size\u003c/h2\u003e\u003cp\u003eWithin the specified time frame, ten cases were included in the RNx, and sixteen cases were included in the LNx. The median age was 59 years (IQR 51.75\u0026ndash;60.25) in the RNx and 49.5 years (IQR 41\u0026ndash;59.5) in the LNx (p\u0026thinsp;=\u0026thinsp;0.15). The RNx had a higher proportion of females (50% vs. 31.3%), a higher median BMI (22.7 vs. 22.35) compared to the LNx; these differences were not statistically significant (p\u0026thinsp;=\u0026thinsp;0.29, p\u0026thinsp;=\u0026thinsp;0.47, respectively). Hypertension was present in 8 cases (80%) in the RNx and 13 cases (81.3%) in the LNx (p\u0026thinsp;=\u0026thinsp;0.66). A history of kidney transplantation was more common in the RNx (70% vs. 18.8%, p\u0026thinsp;=\u0026thinsp;0.01). The most frequent indication for nephrectomy in the RNx was symptom burden (70%), whereas recurrent pyelonephritis was the leading indication in the LNx (43.8%). Reported symptoms included flank pain, abdominal pain, early satiety, cyst infection, hematuria, dyspnea, and limited mobility. The median largest dimension of the right kidney was 19.3 cm in the RNx and 20.5 cm in the LNx (p\u0026thinsp;=\u0026thinsp;0.93). The median largest dimension of the left kidney was 21.6 cm in both groups (p\u0026thinsp;=\u0026thinsp;0.34). The median left kidney volume was 1991 cm\u0026sup3; for RNx and 2344 cm\u0026sup3; for LNx (p\u0026thinsp;=\u0026thinsp;0.26), while the median right kidney volume was 1496 cm\u0026sup3; for RNx and 2128 cm\u0026sup3; for LNx (p\u0026thinsp;=\u0026thinsp;0.72).\u003cb\u003e(Table\u0026nbsp;1)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePerioperative Data\u003c/h3\u003e\n\u003cp\u003eIn the RNx, 6 cases (60%) underwent left nephrectomy, compared with 9 cases (56.3%) in the LNx (p\u0026thinsp;=\u0026thinsp;0.59). A dual-position retroperitoneal approach was used in 3 cases (30%) in the RNx, whereas 14 cases (87.5%) in the LNx underwent a single-position retroperitoneal approach (p\u0026thinsp;=\u0026thinsp;0.005). The median American Society of Anesthesiologists (ASA) physical status was grade II in both groups. The surgical kidneys had comparable sizes between the groups, with a median largest dimension of 20 cm (IQR 16.5\u0026ndash;22.4) in the RNx and 21.6 cm (IQR 18\u0026ndash;25.9) in the LNx (p\u0026thinsp;=\u0026thinsp;0.29). And the median volume of the surgical ellipsoid kidney was 1552 cm\u003csup\u003e3\u003c/sup\u003e (IQR 1107.1\u0026ndash;2428.2) in the RNx and 2240 cm\u003csup\u003e3\u003c/sup\u003e (IQR 1772.2\u0026ndash;3352.9) in the LNx (p\u0026thinsp;=\u0026thinsp;0.14). No significant difference was observed in the median operation time, the median estimated blood loss (EBL), the median hospital stay time, the median diet recovery time between the groups (176 minutes vs 191 minutes, p\u0026thinsp;=\u0026thinsp;0.29; 50 mL vs 100 mL, p\u0026thinsp;=\u0026thinsp;0.17; 9.5 days vs 11.5 days, p\u0026thinsp;=\u0026thinsp;0.37; 2 days vs 2.5 days, p\u0026thinsp;=\u0026thinsp;0.28). In the RNx, none of the cases required preoperative nasogastric tube placement; whereas in the LNx, two cases needed preoperative nasogastric tube placement (0 vs 12.5%, p\u0026thinsp;=\u0026thinsp;0.37). In the RNx, three cases required transfer to the ICU for advanced life support postoperatively, whereas in the LNx, four cases needed ICU transfer for advanced life support (30% vs 25%, p\u0026thinsp;=\u0026thinsp;0.78). \u003cb\u003e(Table\u0026nbsp;2)\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003ePostoperative Complications and Pathology\u003c/h3\u003e\n\u003cp\u003eThe overall incidence of at least one postoperative complication was comparable between the two groups, occurring in 6 cases (60%) in the RNx and 10 cases (62.5%) in the LNx (p\u0026thinsp;=\u0026thinsp;0.61). Blood transfusion was required in one case (10%) in the RNx, compared with four cases (25%) in the LNx (p\u0026thinsp;=\u0026thinsp;0.34). No instances of arteriovenous fistula closure, delayed wound healing, or lymphatic leak were observed in the RNx. In contrast, one case (6.3%) in the LNx developed arteriovenous fistula closure, one case (6.3%) developed lymphatic leak, and one case (6.3%) experienced delayed wound healing. One RNx case (10%) had a mild intestinal obstruction, a complication not seen in the LNx. Postoperative fever lasting more than 3 days was reported in 4 cases (40%) in the RNx and 10 cases (62.5%) in the LNx (p\u0026thinsp;=\u0026thinsp;0.24). Postoperative mental status change was noted in 2 cases (20%) in the RNx and 1 case (6.3%) in the LNx (p\u0026thinsp;=\u0026thinsp;0.32). In the LNx, one case (6.3%) was readmitted within 30 days postoperatively due to a lymphatic leak. No patients in the RNx required readmission for postoperative complications. Postoperative pathological examination confirmed benign disease in 9 cases (90%) in the RNx and 14 cases (87.5%) in the LNx (p\u0026thinsp;=\u0026thinsp;0.68). \u003cb\u003e(Table\u0026nbsp;3)\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003eAnalysis of the Forest Plot Results\u003c/h3\u003e\n\u003cp\u003eBased on the Cramer\u0026rsquo;s V values only mild intestinal obstruction (Cramer\u0026rsquo;s V=0.253, weak-to-moderate association) emerges as a potentially noteworthy postoperative signal, while all other categorical variables lie below the 0.23 threshold and convey little independent predictive information \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e; meanwhile Cohen\u0026rsquo;s d shows that the between-group difference in blood loss (Cohen\u0026rsquo;s d\u0026asymp;-0.6, medium effect) is the sole clearly meaningful disparity, with diet recovery time displaying a small effect (Cohen\u0026rsquo;s d\u0026asymp;-0.4) and both operation time and hospital stay time exhibiting negligible effects (Cohen\u0026rsquo;s d\u0026thinsp;\u0026asymp;\u0026thinsp;0; Cohen\u0026rsquo;s d\u0026asymp;-0.2) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDual-Position Retroperitoneal Approach\u003c/h2\u003e\u003cp\u003eWe present a brief description of a dual-position retroperitoneal approach for RNx: A 61-year-old female was admitted on June 25, 2025, with a history of ADPKD over 20 years, aggravated by dyspnea orthopnea, bilateral lower limb edema, and abdominal distension for more than 3 months. Elevated serum creatinine (peaking at 1032 \u0026micro;mol/L) prompted initiation of regular hemodialysis 8 years ago. Imaging revealed a right kidney measuring 3158cm\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and a left kidney measuring 2681cm\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB\u003cb\u003e).\u003c/b\u003e Cardiomegaly was also noted \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC\u003cb\u003e)\u003c/b\u003e. The patient's symptoms were attributed to compression of the thoracic and abdominal cavities by the massively enlarged polycystic kidneys. A robot-assisted left nephrectomy via a dual-position retroperitoneal approach was planned. The patient was placed in the right lateral decubitus position, and the kidney bridge was elevated to 150\u0026deg; to increase the left costocliac space \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA\u003cb\u003e)\u003c/b\u003e. The initial Trocar layout is shown in the figure below \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB\u003cb\u003e)\u003c/b\u003e. The lateroconal fascia was fanned out and dissected caudally, fully exposing it beneath the extraperitoneal fat. The ureter was dissected along the psoas major muscle. Approaching the renal pedicle revealed severe tissue adhesion. The left renal artery was identified, ligated with a single polymer clip, and transected \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA\u003cb\u003e)\u003c/b\u003e. Subsequently, the left renal vein and its tributaries were gradually exposed, ligated with polymer clips, and transected \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB\u003cb\u003e)\u003c/b\u003e. The kidney was mobilized circumferentially. The ureter was clipped and transected \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC\u003cb\u003e)\u003c/b\u003e. During dissection of the lower pole, the large volume of the polycystic kidney and insufficient working space for the robotic arms prevented complete mobilization. Consequently, the configuration of the trocars was adjusted \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC\u003cb\u003e)\u003c/b\u003e. This revised configuration allowed for complete mobilization of the kidney. The total operation time was 163 minutes, with an estimated blood loss of 50 mL. The patient was discharged on postoperative day 5. At the one-week follow-up, the patient reported significant improvement in abdominal distension and shortness of breath, indicating a successful surgical outcome.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe large volume of polycystic kidneys results in limited operating space and difficult exposure of renal anatomical structures. Due to displacement of abdominal organs caused by compression from polycystic kidneys, the anatomical architecture becomes unclear, increasing the risk of collateral injury during surgery and potential damage to arteries and veins, which may lead to massive hemorrhage. Rupture of renal cysts in polycystic kidneys can cause abdominal infection, subsequently raising the likelihood of postoperative fever and septic shock. Most patients also suffer from renal failure, contributing to elevated perioperative and anesthetic risks. These factors collectively increase the complexity of polycystic kidney nephrectomy, placing significant demands on the surgeon's anatomical knowledge and surgical experience. And native nephrectomy is indicated in patients with the following manifestations: 1.Markedly enlarged kidneys that compromise future space for renal allograft placement; 2.Recurrent cyst infection or hemorrhage; 3.Symptomatic nephrolithiasis; 4.Chronic pain; 5.Mass effect-related symptoms (early satiety, recurrent vomiting, dyspnea); 6.Suspected secondary malignant transformation\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Although traditionally performed via an open approach, associated with high morbidity, laparoscopic techniques have gained popularity. However, the minimally invasive approache can be technically challenging. The robotic platform combines the benefits of minimally invasive surgery with enhanced dexterity and a superior range of motion compared to conventional laparoscopy\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Therefore, performing a unilateral polycystic nephrectomy robotically may be the preferable option.\u003c/p\u003e\u003cp\u003eOur analysis revealed a significant disparity in the preferred surgical approach: the robotic nephrectomy (RNx) group predominantly adopted the preperitoneal approach (70%), whereas the laparoscopic nephrectomy (LNx) group mainly utilized the single-position retroperitoneal approach (87.5%) (p\u0026thinsp;=\u0026thinsp;0.005). This suggests that the robotic system may be better suited for handling massive polycystic kidneys within the more capacious peritoneal cavity, where its three-dimensional magnified vision and wristed instruments facilitate precise dissection between the cyst-laden kidney and adjacent organs. The preperitoneal approach is favored by many urologists due to the larger working space and familiarity with the anatomy. In contrast, the retroperitoneal approach avoids contact with abdominal organs and theoretically minimizes bowel interference, potentially reducing the risk of postoperative intestinal obstruction. It also offers other theoretical advantages, including avoidance of bowel mobilization, direct access to renal hilar structures, and potential reductions in operative time, blood loss, postoperative complications, and hospital stay, without compromising surgical outcomes\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In the RNx group, Cramer\u0026rsquo;s V for the incidence of postoperative mild intestinal obstruction was 0.253. Combined with prior data analysis, this suggests that RNx may be associated with a higher incidence of mild postoperative bowel obstruction. However, it should be noted that the number of preperitoneal procedures in the RNx was substantially higher than in the LNx. Therefore, the observed difference in postoperative bowel obstruction may be attributable to the choice of surgical approach rather than the surgical platform itself.\u003c/p\u003e\u003cp\u003eNotably, based on Cohen\u0026rsquo;s d values and the corresponding forest plot \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, RNx was also associated with a shorter time to diet recovery. It is important to highlight that RNx predominantly employed the preperitoneal approach, which can influence postoperative bowel function recovery. Importantly, even under these conditions, the robotic approach was still linked to a faster resumption of oral intake, further supporting its potentially beneficial role in preserving gastrointestinal function. Although the robotic retroperitoneal approach can make controlling the renal hilum challenging due to the confined working space for very large polycystic kidneys. In this series, the dual-position retroperitoneal technique was successfully implemented in three robotic cases. By intraoperatively adjusting the patient's position and trocar configuration, this technique expands the retroperitoneal working space. Thus, for patients with kidneys too massive for conventional retroperitoneal laparoscopic nephrectomy, the robotic dual-position retroperitoneal approach represents a valuable alternative.\u003c/p\u003e\u003cp\u003eNotably, a significantly higher proportion of patients in the RNx had a history of kidney transplantation (70% vs. 18.8%, p\u0026thinsp;=\u0026thinsp;0.01). For these patients, preserving transplanted kidney function is paramount. The robotic platform, with its enhanced precision and maneuverability, allows for more controlled dissection, potentially reducing the risk of inadvertent injury to adjacent structures, including the pelvic transplanted kidney, thereby offering a potential advantage in safeguarding graft function.\u003c/p\u003e\u003cp\u003eAdditionally, our findings indicate that the RNx group is strongly associated with reduced intraoperative blood loss. However, according to the studies by T\u003csup\u003e13\u003c/sup\u003e et al. and Crocerossa\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e et al., there was no significant difference in blood loss between laparoscopic and robot-assisted nephrectomy during radical nephrectomy, which contradicts our findings. Regarding these discrepancies, we propose several possible explanations. First, in terms of the study population, our research focused on patients undergoing nephrectomy for ADPKD. These patients typically present with massively enlarged kidneys and limited surgical space. In contrast, the aforementioned studies primarily enrolled renal cell carcinoma patients undergoing radical nephrectomy. This divergence in disease spectrum may lead to different responses to robotic-assisted surgery. Second, since ADPKD kidneys are filled with numerous cysts, the inevitable intraoperative rupture of these cysts and subsequent cyst fluid leakage may compromise the surgeon's accurate assessment of blood loss. However, overall, the significance of this discrepancy cannot be overlooked and warrants further validation in large-scale studies.\u003c/p\u003e\u003cp\u003eHowever, this study has several limitations that should be considered when interpreting the results. First, its retrospective design and single-center nature may introduce selection bias and limit the generalizability of the findings. Institutional preferences in surgical approach and perioperative management could influence outcomes. Second, the relatively small sample size, particularly in the robotic cohort, reduces statistical power and may account for the lack of significant differences in many perioperative metrics, despite observable trends favoring the robotic approach. Finally, all robotic procedures were performed by a single highly experienced surgeon, which may further restrict the broader applicability of our technical observations. Therefore, future multi-institutional, prospective studies with larger patient cohorts are necessary to validate these preliminary findings and better elucidate the potential advantages of robotic-assisted nephrectomy in patients with ADPKD.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eRobotic-assisted nephrectomy presents itself as a preferable and advanced surgical option for managing the complexities of ADPKD. It demonstrates potential superior outcomes, including reduced intraoperative blood loss and faster recovery of diet, which may be attributed to the platform's enhanced dexterity, magnified 3D vision, and superior maneuverability. These features are especially beneficial for dissecting massively enlarged, cyst-laden kidneys within the peritoneal cavity and for minimizing the risk of injury to a pelvic transplanted kidney, a critical consideration for a significant subset of patients. The choice of surgical approach is a key determinant of procedural outcomes, with the robotic platform offering flexibility, including the innovative dual-position retroperitoneal technique for challenging cases. However, the observed association with postoperative bowel obstruction appears to be more related to the preperitoneal approach than the robotic technology itself. Despite the encouraging results, the limitations of this study, including its retrospective design and small sample size, necessitate a cautious interpretation. Future prospective, multi-institutional studies with larger cohorts are essential to definitively establish the role and benefits of robotic-assisted nephrectomy in the ADPKD population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENT\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors thank the staff of the Department of Urology, Peking University Third Hospital. \u003cstrong\u003eFUNDING\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is supported by Wu Jieping Medical Foundation (320.6750.2022-03-45).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDISCLOSURES\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXinji Yang, Qiming Zhang, Herong Zhu, Weilong Shi, Shudong Zhang, Xiaofei Hou declare they have no conficts of interests that may be relevant to the contents of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients provided informed consent and the study protocol was approved by the institute’s Committee on Human Research. This study protocol was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee, and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBergmann, C. \u003cem\u003eet al.\u003c/em\u003e Polycystic kidney disease. \u003cem\u003eNat. Rev., Dis. Primers\u003c/em\u003e \u003cstrong\u003e4\u003c/strong\u003e, 50 (2018).\u003c/li\u003e\n\u003cli\u003eWilley, C. J. \u003cem\u003eet al.\u003c/em\u003e Prevalence of autosomal dominant polycystic kidney disease in the european union. \u003cem\u003eNephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc.\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 1356\u0026ndash;1363 (2017).\u003c/li\u003e\n\u003cli\u003eReeders, S. T. \u003cem\u003eet al.\u003c/em\u003e A highly polymorphic DNA marker linked to adult polycystic kidney disease on chromosome 16. \u003cem\u003eNature\u003c/em\u003e \u003cstrong\u003e317\u003c/strong\u003e, 542\u0026ndash;544 (1985).\u003c/li\u003e\n\u003cli\u003eNew treatment paradigms for ADPKD: moving towards precision medicine - PubMed. https://pubmed.ncbi.nlm.nih.gov/28989174/.\u003c/li\u003e\n\u003cli\u003eColbert, G. B., Elrggal, M. E., Gaur, L. \u0026amp; Lerma, E. V. Update and review of adult polycystic kidney disease. \u003cem\u003eDis.-a-mon.: DM\u003c/em\u003e \u003cstrong\u003e66\u003c/strong\u003e, 100887 (2020).\u003c/li\u003e\n\u003cli\u003eNeeff, H. P. \u003cem\u003eet al.\u003c/em\u003e One hundred consecutive kidney transplantations with simultaneous ipsilateral nephrectomy in patients with autosomal dominant polycystic kidney disease. \u003cem\u003eNephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 466\u0026ndash;471 (2013).\u003c/li\u003e\n\u003cli\u003eSpithoven, E. M. \u003cem\u003eet al.\u003c/em\u003e Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe: prevalence and survival--an analysis of data from the ERA-EDTA registry. \u003cem\u003eNephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc.\u003c/em\u003e \u003cstrong\u003e29 Suppl 4\u003c/strong\u003e, iv15-25 (2014).\u003c/li\u003e\n\u003cli\u003eJung, Y. \u003cem\u003eet al.\u003c/em\u003e Volume regression of native polycystic kidneys after renal transplantation. \u003cem\u003eNephrol. Dial. Transplant.: Off. Publ. Eur. Dial. Transpl. Assoc. - Eur. Ren. Assoc.\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 73\u0026ndash;79 (2016).\u003c/li\u003e\n\u003cli\u003eBinsaleh, S., Luke, P. P., Nguan, C. \u0026amp; Kapoor, A. Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique. \u003cem\u003eCan. J. Urol.\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 3340\u0026ndash;3345 (2006).\u003c/li\u003e\n\u003cli\u003eS, A. \u003cem\u003eet al.\u003c/em\u003e Retroperitoneal vs transperitoneal robot-assisted partial nephrectomy: comparison in a multi-institutional setting. \u003cem\u003ePubmed\u003c/em\u003e https://pubmed.ncbi.nlm.nih.gov/30053396/.\u003c/li\u003e\n\u003cli\u003eN, S., P, B., G, S. \u0026amp; Gr, C. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis. \u003cem\u003ePubmed\u003c/em\u003e https://pubmed.ncbi.nlm.nih.gov/38358565/ (2024).\u003c/li\u003e\n\u003cli\u003eA, H.-H. \u003cem\u003eet al.\u003c/em\u003e Robot-assisted partial nephrectomy: a comparison of the transperitoneal and retroperitoneal approaches. \u003cem\u003ePubmed\u003c/em\u003e https://pubmed.ncbi.nlm.nih.gov/23461381/.\u003c/li\u003e\n\u003cli\u003eT, U. \u003cem\u003eet al.\u003c/em\u003e Robot-assisted radical nephrectomy in comparison with open and laparoscopic approaches: a japanese single-institution retrospective study. \u003cem\u003ePubmed\u003c/em\u003e https://pubmed.ncbi.nlm.nih.gov/41182417/ (2025).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table.1\u0026nbsp;\u003c/strong\u003ePatient Characteristic, Indication for Surgery and Bilateral Kidney Size\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobotic\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNephrectomy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e（n=10）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic Nephrectomy（n=16）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5（50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5（31.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (51.8-60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.5 (41-59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.7（18.7-24.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.35 (20.4-24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHypertension (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8（80%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13（81.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePost-Renal Transplant (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7（70%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3（18.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndication for Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTo Create Space for Transplant (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2（12.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSymptomatic (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7（70%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5（31.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConcern for RCC (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2（20%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2（12.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRecurrent Pyelonephritis (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（10%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7（43.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLargest Kidney Dimension on Preoperative CT (cm)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRight Kidney (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.1-25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.8-32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRight Kidney (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.3（16.3-22.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.5（17.8-23.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLeft Kidney (range) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.9-26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.6-33.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLeft Kidney (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.6（17.8-22.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.6（18.4-26.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEllipsoid kidney volume (cm3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRight Kidney (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e801-4764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e566-5069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRight Kidney (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1496（978-2386）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2128（1371-2707）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLeft Kidney (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e845-5042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e481-6219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLeft Kidney (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1991（1349-2476）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2344（1797-3181）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable.2\u0026nbsp;\u003c/strong\u003ePerioperative Data\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobotic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNephrectomy（n=10）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNephrectomy（n=16）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical Strategy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eLeft Nephrectomy (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e6 (60%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e9 (56.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eRetroperitoneal Approach (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3 (30%) (dual-position)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e14 (87.5%) (single-position)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eASA Physical Status Classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eⅡ (Ⅱ-Ⅲ）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eⅡ (Ⅱ-Ⅲ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLargest Dimension of the Surgical Ellipsoid Kidney (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eSurgical Kidney (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e15.8-26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12.6-33.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eSurgical Kidney (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e20（16.5-22.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e21.6（18-25.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVolume of the Surgical Ellipsoid Kidney (cm3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eSurgical Kidney (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e965.8-5042.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e480.9-6219.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eSurgical Kidney (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1552 (1107.1-2428.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2240 (1772.2-3352.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeri-operative Details\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eOperation Time (minutes) (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e176（154.5-187.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e191(158.8-213.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eEstimated Blood Loss (mL) (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e50（30-100）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e100 (50-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eHospital Stay Time (days) (med, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9.5（7.5-12.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e11.5（8.5-13.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eICU Admission (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e3 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e4 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eNasogastric Tube (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2（12.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eTime to Diet Resumption (days) (med, IQR) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2(2-3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2.5(2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable.3\u0026nbsp;\u003c/strong\u003ePostoperative Complications and Pathology\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobotic Nephrectomy（n=10）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic Nephrectomy（n=16）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAny (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBlood Transfusion (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（10%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eA-V Fistula Closure (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（6.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDelayed Wound Healing (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（6.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLymphatic Leak (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（6.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMild Intestinal Obstruction (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostop Fever \u0026gt;3 days (Sepsis) (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostop Mental Status Change (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（6.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30-day Readmission (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（6.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBenign (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9（90%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14（87.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMalignant (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1（10%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2（12.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Polycystic Kidney Disease, Robotic Surgery, Nephrectomy, Surgical Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-8140158/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8140158/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e Laparoscopic unilateral nephrectomy has long been the standard minimally invasive procedure for native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD). With the evolution of the da Vinci Surgical System, robotic nephrectomy (RN) is increasingly adopted and offers potential advantages. However, comparative data between laparoscopic nephrectomy (LN) and RN remain limited. This study compares the perioperative outcomes of LN and RN in ADPKD patients undergoing unilateral nephrectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e We retrospectively reviewed ADPKD patients who underwent LN or RN at our center between February 2019 and September 2025. Patient characteristics, perioperative factors, kidney size, and complication rates were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e In summary, ten cases were included in the RNx, and sixteen cases were included in the LNx. There was no significant difference in most of the parameters, but patients who have undergone kidney transplantation are more inclined to choose robotic nephrectomy (70% vs 18.8%, P=0.01). The RNx demonstrated significantly greater utilization of the preperitoneal approach (70% vs 12.5%, p=0.005). And a forest plot highlights significant differences in surgical outcomes between RNx and LNx groups, with RNx associated with less estimated blood loss (Cohen's d = -0.6) and a shorter diet recovery time (Cohen's d = -0.4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e These findings suggest that robotic unilateral nephrectomy was preferred by patients with a history of kidney transplantation and utilized the preperitoneal approach more frequently. Notably, RNx was associated with reduced blood loss and quicker diet recovery, suggesting potential benefits in postoperative outcomes.\u003c/p\u003e","manuscriptTitle":"Surgical Outcomes of Robotic versus Laparoscopic Unilateral Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Single-Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 07:13:14","doi":"10.21203/rs.3.rs-8140158/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"75597286874049025108104260090406133244","date":"2026-04-19T09:14:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46020457068620832869977657820838293209","date":"2026-03-03T12:23:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-03T05:44:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-19T15:25:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-19T13:19:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2025-11-18T02:49:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2ddfb421-eebb-44b5-a957-8f085c1f3d95","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T07:13:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 07:13:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8140158","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8140158","identity":"rs-8140158","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}