Radical nephrectomy is a standard treatment for renal cell carcinoma (RCC), especially when partial nephrectomy is not suitable. While laparoscopic surgery is well established, robot-assisted approaches are increasingly used. This study compares outcomes of robot-assisted and laparoscopic radical nephrectomy at East Surrey Hospital over a 7-year period.

This retrospective study included 113 adult patients who underwent radical nephrectomy between 2018 and 2024. 50 patients had robot-assisted surgery and 63 had laparoscopic surgery. Data collected included patient demographics, renal function, operative time, TNM stage, complication type and severity, surgical margins, POSSUM scores, and pathway timelines.

The mean age was 66.4 years in the robotic group and 64.8 years in the laparoscopic group. Average operative time was longer in robotic cases (238 vs 191 minutes), but blood loss and transfusion needs were similar. Robotic surgery was used more often for higher-stage tumors. Intraoperative complications were slightly fewer in robotic cases (2 vs 4), and postoperative complications were comparable (13 vs 14). Clavien-Dindo classification showed similar complication severity in both groups, with most being Grade I or II. Margin positivity was slightly lower in robotic cases (2 vs 3). POSSUM scores predicted slightly higher morbidity and mortality in the robotic group. Average time from diagnosis to surgery was 69 days, with some delays exceeding the NHS 62-day cancer pathway. Robotic nephrectomy was introduced in 2020 and accounted for 70% of cases by 2024.

Robot-assisted radical nephrectomy is a safe and effective option, with outcomes comparable to laparoscopic surgery. Although clinical differences are modest, the adoption of robotic surgery is increasing due to better visualisation, precision, ergonomics, and surgeon preference. Ongoing outcome audits and equal access to robotic systems are important as surgical practice evolves.