# First Prospective Multicenter Evaluation of Robotic-assisted Partial Nephrectomy Using the DEXTER Robotic Surgery System

## TL;DR

This study shows that the DEXTER robotic system can safely and effectively perform partial kidney surgeries, with no need to switch to other methods.

## Contribution

First multicenter evaluation of the DEXTER robotic system for partial nephrectomy, demonstrating its safety and usability.

## Key findings

- All surgeries were completed without conversion to open or laparoscopic methods.
- DEXTER showed comparable complication rates and safe warm ischemia times.
- Short-term outcomes support the feasibility and safety of DEXTER for RAPN.

## Abstract

This first multicenter experience with DEXTER-assisted partial nephrectomy demonstrates safety, feasibility, and intuitive usability. All procedures were completed without conversions, complication rates were comparable with those of the established platforms, warm ischemia times remained safe, and the LAP mode enabled flexible robotic-laparoscopic transitions.

Robot-assisted partial nephrectomy (RAPN) is a standard treatment for small renal tumors due to its precision and nephron-sparing properties. The DEXTER Robotic Surgery System is an open, sterile, compact, three-arm multiport system. This study evaluated the intraoperative and early postoperative safety and clinical performance of DEXTER in RAPN.

A prospective observational study was conducted at two hospitals in France. Seven surgeons performed surgeries using DEXTER. The primary endpoints were major complications (Clavien-Dindo grades III–V) and procedural success rate. The secondary endpoints included perioperative outcomes and 30-d follow-up assessment.

Key findings and limitations

Thirty-three patients with a median age of 70 yr (interquartile range [IQR] 60–74) and a body mass index of 26.2 kg/m2 (IQR 23.7–31.2) were enrolled. The clampless technique was used in six cases. When full (22 cases) or selective (five cases) clamping was applied, the median warm ischemia time was 20 min (IQR 14–25). All procedures were completed without conversion to open or laparoscopic surgery. Three Clavien-Dindo grade III events occurred. The median estimated blood loss was 300 ml (IQR 100–600), with no blood transfusions. The skin-to-skin operative time was 170 min (IQR 137–200), and the length of hospital stay was 2 d (IQR 2–3). Limitations included the lack of a learning curve assessment due to a low case load per surgeon, and reduced comparability due to a short follow-up time and lack of a control group.

RAPN with DEXTER is feasible, and the study supports its short-term safety, even during the initial cases. Further studies are needed to assess its long-term performance.

This is a prospective, multicenter cohort study of patients who underwent robot-assisted partial nephrectomy with the DEXTER Robotic Surgery System. During the study, all procedures were completed successfully without any conversions to open or laparoscopic surgery. The results support the short-term safety and feasibility, and highlight the ease of implementation of DEXTER. Further studies are needed to assess its long-term performance.