Membrane anatomy-guided robot-assisted partial nephrectomy: operational definition and association with warm ischemia time in a single-surgeon cohort
In brief
Membrane-guided kidney surgery was linked to 4 minutes less ischemia
In 151 robot-assisted partial kidney surgeries by one surgeon, the membrane-guided approach was associated with a mean warm ischemia time about 4 minutes shorter, even after adjustment for experience and timing. Surgical margin safety was not compromised, and other efficiency measures also improved. Because the study was retrospective and single-surgeon, it cannot establish that the approach caused the differences.
- Journal
- Frontiers in oncology (Q2)
- Published
- 24 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Wenhao Chu, Songbai Yan, Mengying Liao, Rui Hu, Yu Yang, Mingjie He, et al.
- PMID
- 42866336
- DOI
- 10.3389/fonc.2026.1953453
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 18 October 2026): Membrane anatomy‑guided RAPN pathway definition
Abstract
BACKGROUND: A standardized anatomical framework for robot-assisted partial nephrectomy (RAPN) is lacking. This study evaluates a stepwise membrane anatomy-guided pathway and its association with warm ischemia time (WIT) and clamping-phase efficiency, controlling for surgical experience and temporal confounding. METHODS: We evaluated 151 consecutive RAPN cases (30 conventional vs. 121 membrane anatomy-guided) performed by a single-center, single-surgeon cohort using the da Vinci Xi System (2022-2025). Multivariable linear regression with HC3 robust standard errors was performed to assess the primary outcome (WIT), adjusting for clinical covariates and nonlinear cumulative case sequence (natural cubic spline, df = 3). Chronology-adjusted sensitivity analyses and propensity-score overlap weighting were conducted. RESULTS: Despite substantial chronological overlap between pathways, the membrane-guided pathway was independently associated with a 4.05-min reduction in mean WIT (95% CI -6.82 to -1.28; P = 0.004) without compromising surgical margin safety. This effect was consistent across linear, calendar-time, propensity-weighted, and overlap-cohort sensitivity analyses (-3.67 to -4.19 min; all P < 0.05). The membrane-guided approach also significantly increased the odds of WIT ≤ 25 min (adjusted OR 5.25; P = 0.003) and modified Trifecta achievement (adjusted OR 4.97; P = 0.005). CONCLUSION: The membrane anatomy-guided pathway consistently improves clamping-phase efficiency and shortens WIT in RAPN after accounting for learning curves and temporal trends. Given the retrospective design, these findings reflect associative rather than definitive causal effects.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.