No-Touch Adaptive Versus Conventional Robot-Assisted Partial Nephrectomy for Localized Renal Tumours with High Nephrometry Complexity: A Comparative Analysis of Early Outcomes

Background/Objectives: Surgical refinements in robot-assisted partial nephrectomy (RAPN) aim to reduce morbidity and optimize renal function preservation, particularly in patients with high-complexity renal tumours. This study describes the no-touch adaptive technique for RAPN and compares its perioperative outcomes, postoperative complications, and resulting early renal function with those of the conventional approach. Methods: A cohort of 72 consecutive patients with high-complexity renal tumours undergoing RAPN was evaluated. The study group included 38 patients treated with the no-touch adaptive technique, while 34 patients underwent the conventional approach. The no-touch adaptive technique consisted of sutureless, off-clamp, simple tumour enucleation with incremental haemostasis and the option to shift to arterial clamping, tumour enucleoresection, or renorrhaphy as needed. The conventional technique involved on-clamp minimal enucleoresection with double-layer renorrhaphy. Outcomes assessed included completion of a fully no-touch procedure, perioperative metrics, 90-day postoperative complications, and 3-month renal function change from baseline. Results: Baseline characteristics were comparable between groups. A fully no-touch RAPN was achieved in 30/38 (79%) patients. Adaptations were required in eight cases: shift to main arterial clamping (n = 2), renorrhaphy (n = 5), or both (n = 1), with one conversion to total nephrectomy due to intractable bleeding. Estimated blood loss was similar between groups (study: 150 mL [IQR 75–250] vs. control: 180 mL [IQR 100–400]). Length of stay was significantly shorter in the study group (3 days [IQR 3–4]) compared with controls (5 days [IQR 6–8]). Any-grade 90-day complications were significantly lower with the no-touch technique (21% vs. 56%, p < 0.01). Clinically significant 3-month eGFR decline occurred in 14% of controls versus 0% of study patients (p = 0.02). Conclusions: The no-touch adaptive RAPN technique is feasible in high-complexity renal tumours and provides reduced morbidity and superior early renal function preservation compared with the conventional approach.