{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:36:08Z","timestamp":1787027768878,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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\u2013250] vs. control: 180 mL [IQR 100\u2013400]). Length of stay was significantly shorter in the study group (3 days [IQR 3\u20134]) compared with controls (5 days [IQR 6\u20138]). Any-grade 90-day complications were significantly lower with the no-touch technique (21% vs. 56%, p &lt; 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.<\/jats:p>","DOI":"10.3390\/cancers18101577","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:04:36Z","timestamp":1778601876000},"page":"1577","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["No-Touch Adaptive Versus Conventional Robot-Assisted Partial Nephrectomy for Localized Renal Tumours with High Nephrometry Complexity: A Comparative Analysis of Early Outcomes"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6995-246X","authenticated-orcid":false,"given":"Gianluca","family":"Giannarini","sequence":"first","affiliation":[{"name":"Urology Unit, Santa Maria Della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Crestani","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria Della Misericordia University Hospital, 33100 Udine, Italy"},{"name":"Department of Medicine (DMED), University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Lista","sequence":"additional","affiliation":[{"name":"Oncological Urology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Corsi","sequence":"additional","affiliation":[{"name":"Oncological Urology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gioacchino","family":"De Giorgi","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria Della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Minardi","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria Della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0564-7415","authenticated-orcid":false,"given":"Luca","family":"Di Gianfrancesco","sequence":"additional","affiliation":[{"name":"Urology Unit, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"De Marchi","sequence":"additional","affiliation":[{"name":"Urology Unit, Humanitas Gavazzeni, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2730-0402","authenticated-orcid":false,"given":"Antonio","family":"Amodeo","sequence":"additional","affiliation":[{"name":"Oncological Urology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Porreca","sequence":"additional","affiliation":[{"name":"Urology Unit, Humanitas Gavazzeni, 24125 Bergamo, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.eururo.2025.02.020","article-title":"European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update","volume":"87","author":"Bex","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.eururo.2016.11.038","article-title":"Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses","volume":"72","author":"Kim","year":"2017","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.eururo.2021.01.021","article-title":"Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass","volume":"80","author":"Chandrasekar","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.euf.2019.11.004","article-title":"Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis","volume":"6","author":"Veccia","year":"2020","journal-title":"Eur. Urol. Focus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.juro.2017.12.086","article-title":"Impact of Surgical Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis","volume":"200","author":"Cacciamani","year":"2018","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.juro.2018.04.079","article-title":"Impact of Host Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis","volume":"200","author":"Cacciamani","year":"2018","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.eururo.2019.11.024","article-title":"Three-dimensional Augmented Reality Robot-assisted Partial Nephrectomy in Case of Complex Tumours (PADUA \u226510): A New Intraoperative Tool Overcoming the Ultrasound Guidance","volume":"78","author":"Porpiglia","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.ajur.2024.09.010","article-title":"Robot-assisted partial nephrectomy for renal cell carcinoma: A narrative review of different clinical scenarios","volume":"12","author":"Grosso","year":"2025","journal-title":"Asian J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.eururo.2025.08.010","article-title":"Comparison of Single- and Multiport Robot-assisted Approaches in Prostate and Renal Surgery: A Systematic Review and Meta-analysis","volume":"88","author":"Ficarra","year":"2025","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.eururo.2009.07.040","article-title":"Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery","volume":"56","author":"Ficarra","year":"2009","journal-title":"Eur. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.eururo.2010.10.002","article-title":"\u201cZero Ischemia\u201d partial nephrectomy: Novel laparoscopic and robotic technique","volume":"59","author":"Gill","year":"2011","journal-title":"Eur. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.juro.2011.11.100","article-title":"Laparoscopic and robotic partial nephrectomy with controlled hypotensive anesthesia to avoid hilar clamping: Feasibility, safety and perioperative functional outcomes","volume":"187","author":"Papalia","year":"2012","journal-title":"J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.eururo.2019.11.015","article-title":"Intraoperative Adverse Incident Classification (EAUiaiC) by the European Association of Urology ad hoc Complications Guidelines Panel","volume":"77","author":"Biyani","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1097\/PAS.0b013e318299f0fb","article-title":"The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters","volume":"37","author":"Delahunt","year":"2013","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.eururo.2011.10.033","article-title":"Reporting and grading of complications after urologic surgical procedures: An ad hoc EAU guidelines panel assessment and recommendations","volume":"61","author":"Mitropoulos","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New Creatinine- and Cystatin C\u2013Based Equations to Estimate GFR without Race","volume":"385","author":"Inker","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"(2024). Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1053\/j.ajkd.2014.07.030","article-title":"GFR decline as an end point for clinical trials in CKD: A scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration","volume":"64","author":"Levey","year":"2014","journal-title":"Am. J. Kidney Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.euf.2017.02.012","article-title":"Renal Preservation and Partial Nephrectomy: Patient and Surgical Factors","volume":"2","author":"Marconi","year":"2016","journal-title":"Eur. Urol. Focus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.euros.2023.10.001","article-title":"Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group","volume":"58","author":"Shrivastava","year":"2023","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.euros.2023.03.008","article-title":"Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review","volume":"52","author":"Bertolo","year":"2023","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.euo.2018.11.008","article-title":"Young Academic Urologists Kidney Cancer Working Group of the European Urological Association. Systematic Review and Pooled Analysis of the Impact of Renorrhaphy Techniques on Renal Functional Outcome After Partial Nephrectomy","volume":"2","author":"Bertolo","year":"2019","journal-title":"Eur. Urol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1111\/bju.14537","article-title":"Suture techniques during laparoscopic and robot-assisted partial nephrectomy: A systematic review and quantitative synthesis of peri-operative outcomes","volume":"123","author":"Bertolo","year":"2019","journal-title":"BJU Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5260131","DOI":"10.1155\/2022\/5260131","article-title":"The Outcome of Sutureless in Partial Nephrectomy: A Systematic Review and Meta-Analysis","volume":"2022","author":"Liu","year":"2022","journal-title":"BioMed Res. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.eururo.2018.08.042","article-title":"The Learning Curve for Robot-assisted Partial Nephrectomy: Impact of Surgical Experience on Perioperative Outcomes","volume":"75","author":"Larcher","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bravi, C.A., Junior ERUS\/Young Academic Urologist Working Group on Robot-Assisted Surgery, Dell\u2019oglio, P., Pecoraro, A., Khene, Z.E., Campi, R., Diana, P., Re, C., Giulioni, C., and Tuna Beksac, A. (2024). Surgical Experience and Functional Outcomes after Laparoscopic and Robot-Assisted Partial Nephrectomy: Results from a Multi-Institutional Collaboration. J. Clin. Med., 13.","DOI":"10.3390\/jcm13196016"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"288","DOI":"10.4103\/iju.iju_154_22","article-title":"Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study","volume":"38","author":"Sharma","year":"2022","journal-title":"Indian J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.euros.2025.02.001","article-title":"Nephrometry Scores Based on Three-dimensional Virtual Models Improve the Accuracy of Predicting Postoperative Complications After Robotic Partial Nephrectomy: Results from a Collaborative ERUS Validation Study","volume":"74","author":"Amparore","year":"2025","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Brassetti, A., Misuraca, L., Anceschi, U., Bove, A.M., Costantini, M., Ferriero, M.C., Guaglianone, S., Mastroianni, R., Torregiani, G., and Covotta, M. (2023). Sutureless Purely Off-Clamp Robot-Assisted Partial Nephrectomy: Avoiding Renorrhaphy Does Not Jeopardize Surgical and Functional Outcomes. Cancers, 15.","DOI":"10.3390\/cancers15030698"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"82","DOI":"10.23736\/S0393-2249.19.03570-7","article-title":"Surgical quality, cancer control and functional preservation: Introducing a novel trifecta for robot-assisted partial nephrectomy","volume":"72","author":"Brassetti","year":"2020","journal-title":"Minerva Urol. Nefrol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"De Nunzio, C., Tema, G., Brassetti, A., Anceschi, U., Bove, A.M., D\u2019annunzio, S., Ferriero, M., Mastroianni, R., Misuraca, L., and Guaglianone, S. (2024). Purely Off-Clamp Sutureless Robotic Partial Nephrectomy for Novice Robotic Surgeons: A Multi-Institutional Propensity Score-Matched Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13123553"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1577\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T13:10:44Z","timestamp":1778677844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1577"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["cancers18101577"],"URL":"https:\/\/doi.org\/10.3390\/cancers18101577","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}