Surgical Outcomes of Robotic versus Laparoscopic Unilateral Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Single-Center Retrospective Study

Purpose Laparoscopic unilateral nephrectomy has long been the standard minimally invasive procedure for native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD). With the evolution of the da Vinci Surgical System, robotic nephrectomy (RN) is increasingly adopted and offers potential advantages. However, comparative data between laparoscopic nephrectomy (LN) and RN remain limited. This study compares the perioperative outcomes of LN and RN in ADPKD patients undergoing unilateral nephrectomy. Methods We retrospectively reviewed ADPKD patients who underwent LN or RN at our center between February 2019 and September 2025. Patient characteristics, perioperative factors, kidney size, and complication rates were compared. Results In summary, ten cases were included in the RNx, and sixteen cases were included in the LNx. There was no significant difference in most of the parameters, but patients who have undergone kidney transplantation are more inclined to choose robotic nephrectomy (70% vs 18.8%, P=0.01). The RNx demonstrated significantly greater utilization of the preperitoneal approach (70% vs 12.5%, p=0.005). And a forest plot highlights significant differences in surgical outcomes between RNx and LNx groups, with RNx associated with less estimated blood loss (Cohen's d = -0.6) and a shorter diet recovery time (Cohen's d = -0.4). Conclusion These findings suggest that robotic unilateral nephrectomy was preferred by patients with a history of kidney transplantation and utilized the preperitoneal approach more frequently. Notably, RNx was associated with reduced blood loss and quicker diet recovery, suggesting potential benefits in postoperative outcomes.