Comparative analysis of perioperative outcomes, complications, and early renal function after no-touch adaptive versus conventional robot-assisted partial nephrectomy for clinically localized renal tumours

Background/Objectives: Robot-assisted partial nephrectomy (RAPN) has become the preferred approach for localized renal tumours, yet the optimal surgical technique remains a matter of debate. The goal of ongoing improvements is to maximize renal function preservation while lowering morbidity. In this study, we compared perioperative outcomes, postoperative complications, and early renal function between the no-touch adaptive RAPN technique, designed to minimize vascular and parenchymal trauma, and the conventional approach. Methods: We retrospectively analysed 342 consecutive patients undergoing RAPN for localized renal tumours between June 2017 and June 2025 at a single tertiary referral centre. Patients were grouped according to the surgical technique for RAPN, no-touch adaptive (n=133) versus conventional (n=209). The no-touch adaptive technique consisted of a sutureless off-clamp simple tumour enucleation with incremental haemostasis and on-demand shift to either arterial clamping, tumour enucleoresection or renorrhaphy. The conventional technique consisted of an on-clamp minimal enucleoresection with double-layer renorrhaphy. Perioperative outcomes, 90-day complications, and changes in renal function at 3 months were compared. Exploratory multivariable logistic regression was performed to identify predictors of complications. Results: A fully no-touch procedure was completed in 84% of cases. Compared with conventional RAPN, the no-touch group demonstrated significantly shorter length of stay (3 vs 5 days, p<0.01) and lower 90-day readmission rates (0% vs 4.3%, p=0.01). Overall complications (20% vs 41%, p<0.01) and major complications (4% vs 12%, p=0.02) were less frequent in the no-touch group, with no single case of delayed vascular bleeding. At 3 months, only the conventional group experienced a significant decline in eGFR (p=0.03). Low tumour complexity and the no-touch approach independently predict a lower risk of complications on multivariable analysis. Conclusions: No-touch adaptive RAPN was associated with fewer complications, faster recovery, and better short-term renal function compared with conventional RAPN. Larger and prospective studies are warranted to validate its role in clinical practice.