Editor's Note: From August 8th to 11th, 2024, the Annual Meeting of the Urology Physicians Branch of the Chinese Medical Doctor Association (CUDA) was held in Xi'an. Organized by the Chinese Medical Doctor Association and the Urology Physicians Branch, and hosted by Xijing Hospital of the Air Force Medical University, with support from the Urology Physicians Branch of the Shaanxi Medical Doctor Association, the conference showcased the latest achievements in urology from a broad and multidimensional perspective under the theme "Healthy China, Urology Leads the Way." At the conference, Urology Frontier interviewed Dr. Xiongjun Ye from the Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, who shared insights on the advantages of partial nephrectomy, discussed the approaches for robot-assisted partial nephrectomy, and explored the optimization directions for this surgical technique, offering valuable clinical guidance.

01

Urology Frontier: Compared to radical nephrectomy, what are the advantages of partial nephrectomy?

Dr. Xiongjun Ye: Partial nephrectomy offers three main advantages compared to radical nephrectomy:

1. Tumor Control: Partial nephrectomy provides comparable tumor control to radical nephrectomy. Previous literature and clinical studies have consistently demonstrated that partial nephrectomy can achieve tumor control outcomes equivalent to those of radical nephrectomy.
2. Renal Function Preservation: By removing only the tumor and a portion of the renal parenchyma, partial nephrectomy significantly preserves renal function compared to radical nephrectomy. The preserved kidney function in partial nephrectomy patients lays a solid foundation for subsequent medical treatments.
3. Psychological Benefits: Partial nephrectomy preserves part of the kidney and its function, which can have a positive psychological impact on patients as they do not lose an entire organ due to the disease.

02

Urology Frontier: How should the surgical approach be optimized in robot-assisted partial nephrectomy?

Dr. Xiongjun Ye: In robot-assisted laparoscopic partial nephrectomy, the choice of surgical approach should be based on a comprehensive consideration of tumor size, location, and the relationship between the tumor and the renal vascular system, venous system, and collecting system. When the tumor is located at the upper pole or the posterior lip of the renal hilum, I personally prefer a retroperitoneal approach for the robot-assisted surgery. When the tumor is located at the lower pole or the anterior lip of the renal hilum, I usually opt for a transperitoneal approach. These approaches are not the only options, and in clinical practice, we must consider the patient’s individual characteristics, tumor size, and location to determine the most appropriate surgical approach.

03

Urology Frontier: Based on your presentation at this conference, do you believe that robot-assisted surgery is the ultimate solution for partial nephrectomy?

Dr. Xiongjun Ye: My personal answer is no. When discussing whether a particular surgical technique is the ultimate solution, we must prioritize tumor control. First, open surgery still has a place in partial nephrectomy. When the tumor is large or when there is a risk of cystic tumor rupture, we tend to prefer open surgery to perform partial nephrectomy within a limited time. Additionally, some very complex partial nephrectomies require a workbench surgery that cannot be accomplished with robot-assisted surgery. Second, when the tumor is lobulated, has satellite lesions, invades the renal capsule, perirenal fat, or even the peritoneum, we often recommend radical nephrectomy rather than partial nephrectomy. In summary, when performing robot-assisted laparoscopic partial nephrectomy, tumor control should always be the top priority.

04

Urology Frontier: What are the future optimization directions for robot-assisted laparoscopic surgery?

Dr. Xiongjun Ye: Robot-assisted laparoscopic surgery has brought revolutionary and innovative changes to the field of renal cancer surgery, offering many advantages. In its future development, I believe there are several areas for improvement:

1. Miniaturization and Intelligence: The mechanical arms of robots should develop toward miniaturization and intelligence, bringing more revolutionary changes to the field of renal cancer surgery.
2. Integration with Artificial Intelligence: Robot-assisted surgery should be combined with artificial intelligence technology to achieve real-time intraoperative navigation, guiding the development of precise surgical treatments.
3. Advancement in Telemedicine: The future of robot-assisted technology should move toward telemedicine. Combining remote technology with robotic technology will provide more applicable scenarios for renal cancer surgery, greatly benefiting patients with renal cancer.

Dr. Xiongjun Ye:

• Chief Physician, Professor, and Doctoral Supervisor, Department of Urology, Cancer Hospital, Chinese Academy of Medical Sciences.
• Current Roles: Member of the CUA Robotics Group. Member of the CUDA Reconstruction and Repair Group. Member of the CSCO Renal Cancer/Urothelial Cancer Committee. Expert on the CUA Prostate Cancer Guidelines Writing Group. Expert on the CSCO Urothelial Cancer Guidelines Writing Group. Vice Chairman of the Urology Branch of the Chinese Society of Sexology. Vice Chairman of the Youth Committee of the Urology Branch of the Chinese Research Hospital Association. Member of the Medical Robotics Professional Committee of the Chinese Association of Automation. Member of the Endoscopy Society of the Chinese Medical Doctor Association. Vice Chairman of the Youth Committee of the Beijing Anti-Cancer Association Urological Oncology Branch. Vice Chairman of the Youth Committee of the Beijing Health Promotion Association Urology Branch. Standing Director of the Urology Specialist Physicians Branch of the Beijing Medical Doctor Association. Member of the Digital Urology Group of the Beijing Medical Association Urology Branch. Member of the Urological Oncology Branch of the Beijing Tumor Society. Corresponding Editor of the Chinese Journal of Urology. Editorial Board Member of the Journal of Urology (Electronic Edition). Editorial Board Member of the Chinese edition of BJU International. Editorial Board Member of the Chinese edition of Current Opinion in Urology.