ArticleFrontiers in oncology2026
Membrane anatomy-guided robot-assisted partial nephrectomy: operational definition and association with warm ischemia time in a single-surgeon cohort.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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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; 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.
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