Robotic partial nephrectomy is inching toward the gold standard for small renal masses-a narrative review.

Background and Objective: Management of small renal masses has changed significantly since the concept of radical nephrectomy for kidney cancer was described in 1969. As improved imaging allowed the early detection of small renal masses, minimally invasive partial nephrectomies became the standard treatment to preserves kidney function. The DaVinci robotic platform allowed many of these surgeries to be performed robotically, with the aid of new technologies that refine dissection. The purpose of this review is to describe the progression of partial nephrectomy technique over time and its impact on patient outcomes. Methods: PubMed was searched for all studies tracking the change in proportion of partial nephrectomies based on surgical approach from 2000-2026. The search was limited to English language studies. Studies that did not describe the proportion of robotic partial nephrectomies were excluded. A non-systemic literature review was then performed using keywords associated with associated advances in surgical approach and technology. Key Content and Findings: Early partial nephrectomies were predominantly performed through open surgery. In the early 21st century there was a small growth in laparoscopic surgery, which was quickly overtaken by robotic partial nephrectomy after the introduction of the DaVinci robot in the early 2000s. Robotic partial nephrectomy would become the predominant surgical approach by the early 2010s in the United States. This trend would be mirrored internationally, albeit with slower adoption of the robotics. The predominance of robotic partial nephrectomy can be attributed to superior post-operative outcomes, mediated by the integration of new technology into the robotic platform. Conclusions: Partial nephrectomy has become a guideline recognized standard for managing small renal masses. The robotic approach has become favored due to superior post-operative outcomes mediated by advances in technology and surgical technique. Further advances are expected to refine the robotic partial nephrectomy, inching it towards the clinical "gold standard".