Safety and Efficacy of Sutureless off-clamp Robot-Assisted Partial Nephrectomy: A Systematic Review and Meta-Analysis

Abstract

Objective: To compare perioperative, renal functional, oncological, and safety outcomes of omission of routine renorrhaphy versus conventional renorrhaphy during off-clamp robot-assisted partial nephrectomy (RAPN). Methods: PubMed, the Cochrane Library, Embase, Web of Science, and the Chinese Biomedical Literature Database were searched from inception through May 2026. Comparative studies were synthesized using RevMan 5.4.1. Results: Four studies involving 787 patients were included. No statistically significant between-group differences were demonstrated for operative time (WMD -17.32 min, 95% CI -43.31 to 8.68), hospital stay (WMD -0.50 days, 95% CI -1.38 to 0.37), early postoperative eGFR change (WMD 1.81 mL/min/1.73 m², 95% CI -0.49 to 4.10), acute or early renal deterioration (RR 0.36, 95% CI 0.12 to 1.12), estimated blood loss (WMD -149.91 mL, 95% CI -336.58 to 36.75), transfusion (RR 1.36, 95% CI 0.46 to 4.00), positive surgical margin (RR 0.42, 95% CI 0.16 to 1.15), or major postoperative complications (RR 0.87, 95% CI 0.31 to 2.41). Conclusions: The available studies did not demonstrate statistically significant differences in the assessed outcomes. However, the small, predominantly observational evidence base and wide confidence intervals preclude conclusions of equivalence or non-inferiority. Omission of routine renorrhaphy should remain a selective intraoperative decision.