title: Robotic partial nephrectomy for renal tumors larger than 4 cm: a systematic review and meta-analysis.
abstract: BACKGROUND
  With the establishment of minimally invasive surgery in society, the robot has been increasingly widely used in the urologic field, including in partial nephrectomy. This study aimed to comprehensively summarize the currently available evidence on the feasibility and safety of robotic partial nephrectomy for renal tumors of >4 cm.
  
  
  RESULTS
  An electronic database search of PubMed, Scopus, Web of Science, and the Cochrane Library was performed. This systematic review and meta-analysis was based on all relevant studies that assessed robotic partial nephrectomy for renal tumors of >4 cm. Five studies were included. The meta-analysis involved 3 studies from 11 institutions including 154 patients, while the narrative review involved the remaining 2 studies from 5 institutions including 64 patients. In the meta-analysis, the mean ischemic time, operation time, and console time was 28, 319, and 189 minutes, respectively. The estimated blood loss and length of stay was 317 ml and 3.8 days, respectively. The rates of conversion, positive margins, intraoperative complications, postoperative complications, hilar clamping, and collecting system repair were 7.0%, 3.5%, 7.0%, 9.8%, 93.9%, and 47.5%, respectively. The narrative review showed results similar to those of the meta-analysis.
  
  
  CONCLUSIONS
  Robotic partial nephrectomy is feasible and safe for renal tumors of >4 cm with an acceptable warm ischemic time, positive margin rate, conversion rate, complication rate, operation time, estimated blood loss, and length of stay.
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China ; Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China.
authors.forename: Liangkuan
authors.initials: L
authors.lastname: Bi
authors.forename: Caixia
authors.initials: C
authors.lastname: Zhang
authors.forename: Kaiwen
authors.initials: K
authors.lastname: Li
authors.forename: Xinxiang
authors.initials: X
authors.lastname: Fan
authors.forename: Kewei
authors.initials: K
authors.lastname: Xu
authors.forename: Jinli
authors.initials: J
authors.lastname: Han
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Wen
authors.initials: W
authors.lastname: Dong
authors.forename: Xiangyun
authors.initials: X
authors.lastname: Yang
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
authors.forename: Tianxin
authors.initials: T
authors.lastname: Lin
mesh_terms: D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome