**8. Conclusion**

• An apron of Perinephric fat can be placed behind the posterior surface of the kidney, to anteriorly displace the kidney. This improves access to posterior and lateral tumours. If

This is our summarised technique that is performed in our practice, which can be adopted by

Both EAU and AUA guidelines advise minimally invasive surgery if possible, however advise caution if perioperative, oncological or functional outcomes are at risk of compromise [32, 33]. In fact, EAU recommend partial nephrectomy over radical in patients with T1 tumours, even if an open approach is warranted. Any approach for PN is valid based on the surgeons skill

The EAU advise that despite the similar cancer specific survival and recurrence free survival for pT1 tumours in the comparison of partial versus radical nephrectomy; partial nephrectomy is still the ideal treatment in view of minimising impairment to renal function and preventing metabolic and cardiovascular disorders in the long term. Retrospective studies have revealed no difference in long term overall and cancer specific survival between laparoscopic

Prospective comparison of robotic-assisted versus open partial nephrectomy found significant improvement in estimated blood loss and length of stay in the cohort undergoing RAPN. Early and short term complications, operative time and warm ischaemia time were similar between both approaches [36]. Robotic-assisted surgery was found be superior to laparoscopic PN with regards to conversion to open, conversion to radical nephrectomy, warm ischaemia time and length of stay. This meta-analysis of 23 studies also concluded no difference in short term postoperative complications, operative time, estimated blood loss and positive margins [37].

We describe a few developing technologies which may be of interest to urologists.

the CT scan with three dimensional reconstruction of the renal units [38].

Reconstruction and navigation technology appears to have an emerging role in both preoperative and intraoperative planning and operative assistance. A diverse group of 108 urologists of various training experience changed their views to feel an RAPN over a radical nephrectomy was indicated from 47–75% of the 20 complex cases reviewed following a re-review of

Hyperaccuracy three dimensional (HA3D) is an emerging technology allowing three dimensional reconstructions, enabling virtual mapping of the in-vivo structures with the reconstructed model during the partial nephrectomy. A small sample sized study in complex renal tumours (PADUA >10), using this HA3D technology enabled intraoperative management of the pedicle

there is inadequate Perinephric fat, tonsil swabs can be placed instead.

departments interested in developing a robotic partial nephrectomy service.

**6. Indication and guidelines**

and open partial nephrectomies [34, 35].

**7. Future developments**

and preference.

242 Evolving Trends in Kidney Cancer

Our technique offers a standardised approach to aspiring urologists in performing roboticassisted partial nephrectomies. We expect urologists to have the appropriate level of training and supervision prior to performing this procedure. We highlight a variety of tips and tricks that have benefitted our team in performing safer and easier surgery. We describe the stance of guidelines of robotic surgery in partial nephrectomies. We highlight emerging technologies which may become incorporated into the future practice of robotic surgery.
