{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:30:47Z","timestamp":1786681847541,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00789fa95","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Robot-assisted partial nephrectomy (RAPN) has become the preferred surgical approach for localized renal tumours, yet the optimal surgical technique remains uncertain. Ongoing refinements aim to reduce morbidity while maximizing renal function preservation. 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 analyzed 387 consecutive patients undergoing RAPN for localized renal tumours between June 2017 and February 2026 at a single tertiary referral centre. Patients were treated with either the no-touch adaptive (n = 178) or conventional (n = 209) technique. The no-touch approach consisted of sutureless off-clamp simple tumour enucleation with incremental haemostasis and on-demand conversion to arterial clamping, tumour enucleoresection, or renorrhaphy when required. The conventional technique consisted of an on-clamp minimal enucleoresection with double-layer renorrhaphy. Completion rate of a fully no-touch procedure was assessed in the study group, and perioperative outcomes, 90-day complications, and renal function at 3 months were compared between the groups. Exploratory multivariable logistic regression identified predictors of postoperative complications. Absolute and relative changes in estimated glomerular filtration rate (eGFR) from baseline were analyzed, and a linear regression model adjusted for baseline eGFR was used to compare postoperative renal function between the groups. Results: Among the 175 evaluable patients after excluding three immediate conversions to radical nephrectomy before tumour excision, a fully no-touch procedure was completed in 153 (87.4%). Compared with conventional RAPN, the no-touch group had a significantly shorter hospital stay (3 vs. 5 days, p &lt; 0.01), lower 90-day readmission rate (0% vs. 4.3%, p = 0.01), fewer overall complications (16.3% vs. 40.7%, p &lt; 0.01), and fewer major complications (3.9% vs. 11%, p = 0.02), with no cases of delayed vascular bleeding. Low tumour complexity and the no-touch technique independently predicted a lower risk of postoperative complications. The median decline in eGFR from baseline to 3 months was significantly smaller in the no-touch group, which also showed a lower rate of clinically meaningful renal function deterioration (eGFR decline \u2265 30%; 1.1% vs. 5.7%, p = 0.03). After adjustment for baseline eGFR, the no-touch adaptive technique was associated with a 5.4 mL\/min\/1.73 m2 higher 3-month eGFR than the conventional technique (95% CI 3.6\u20137.2; p &lt; 0.001). Conclusions: Within the limitations of this retrospective comparative study, the no-touch adaptive technique for RAPN was associated with lower perioperative morbidity and better preservation of early renal function than the conventional approach. These findings support further prospective multicentre studies to determine the reproducibility, durability, and clinical relevance of this surgical strategy.<\/jats:p>","DOI":"10.3390\/jcm15166233","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:11:36Z","timestamp":1786525896000},"page":"6233","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"15","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":"Eleonora","family":"Bovolenta","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Lista","sequence":"additional","affiliation":[{"name":"Oncological Urology Unit, Veneto Institute of Oncology IOV\u2013IRCCS, 35128 Padua, 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":"Jeanlou","family":"Collavino","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Ermacora","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Franzese","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrovita","family":"Kungulli","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"}]},{"given":"Marco","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Segalla","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasa","family":"Sekulovic","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Traunero","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6157-354X","authenticated-orcid":false,"given":"Matteo Alberto","family":"Maniero","sequence":"additional","affiliation":[{"name":"Department of Medicine (DMED), University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Claps","sequence":"additional","affiliation":[{"name":"Oncological Urology Unit, Veneto Institute of Oncology IOV\u2013IRCCS, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Abbinante","sequence":"additional","affiliation":[{"name":"Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, 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"}]},{"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\u2013IRCCS, 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, 20072 Pieve Emanuele, 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"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","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_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":"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_4","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_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":"9","DOI":"10.23736\/S2724-6051.24.05772-0","article-title":"Partial nephrectomy for renal tumors: Recommendations of the Italian Society of Urology RCC working group","volume":"76","author":"Volpe","year":"2024","journal-title":"Minerva Urol. Nephrol."},{"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":"659","DOI":"10.1007\/s00345-022-03964-x","article-title":"Robotic partial nephrectomy in 3D virtual reconstructions era: Is the paradigm changed?","volume":"40","author":"Amparore","year":"2022","journal-title":"World J. Urol."},{"key":"ref_10","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_11","doi-asserted-by":"crossref","unstructured":"Giannarini, G., Crestani, A., Lista, G., Corsi, P., De Giorgi, G., Minardi, D., Di Gianfrancesco, L., De Marchi, D., Amodeo, A., and Porreca, A. (2026). No-touch adaptive versus conventional robot-assisted partial nephrectomy for localized renal tumours with high nephrometry complexity: A comparative analysis of early outcomes. Cancers, 18.","DOI":"10.3390\/cancers18101577"},{"key":"ref_12","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_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-Based 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":"375","DOI":"10.1111\/bju.16250","article-title":"Off-clamp vs on-clamp robot-assisted partial nephrectomy: A systematic review and meta-analysis","volume":"133","author":"Fong","year":"2024","journal-title":"BJU Int."},{"key":"ref_23","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_24","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_25","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_26","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_27","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_28","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_29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1089\/lap.2018.0364","article-title":"Renal Arterial Pseudoaneurysm After Partial Nephrectomy: Literature Review and Single-Center Analysis of Predictive Factors and Renal Functional Outcomes","volume":"29","author":"Chavali","year":"2019","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_30","first-page":"26","article-title":"Assessing Renal Function Recovery Following Treatment for Post-Robot-Assisted Partial Nephrectomy Renal Artery Pseudoaneurysm","volume":"40","author":"Kahn","year":"2026","journal-title":"J. Endourol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Brassetti, A., Tuderti, G., Anceschi, U., Bove, A.M., Bologna, E., Capecchi, L., Chiacchio, G., D\u2019annunzio, S., Ferriero, M., and Flammia, R.S. (2026). Sutureless Purely Off-clamp Robotic Partial Nephrectomy: Evidence from a Randomized Controlled Noninferiority Trial. Eur. Urol., online ahead of print.","DOI":"10.1016\/j.eururo.2026.04.019"},{"key":"ref_32","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_33","doi-asserted-by":"crossref","unstructured":"Giannarini, G., Amodeo, A., Porreca, A., and Crestani, A. (2026). Re: Aldo Brassetti, Gabriele Tuderti, Umberto Anceschi, et al. Sutureless Purely Off-clamp Robotic Partial Nephrectomy: Evidence from a Randomized Controlled Noninferiority Trial. Eur. Urol., in press.","DOI":"10.1016\/j.eururo.2026.06.007"},{"key":"ref_34","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":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6233\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:22:57Z","timestamp":1786681377000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":34,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166233"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166233","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]}}}