# Robotic Vessel Sealer vs. Robotic Bipolar Grasper in Partial Nephrectomy

## TL;DR

This study compares two robotic tools used in kidney surgery, finding that one reduces blood loss but doesn't improve overall efficiency.

## Contribution

The study provides a direct comparison of robotic vessel sealer and bipolar grasper in partial nephrectomy with a focus on blood loss and surgical efficiency.

## Key findings

- The robotic vessel sealer significantly reduced estimated blood loss compared to the bipolar grasper.
- There was no significant difference in ischemia time or postoperative complications between the two groups.
- Both devices were found to be safe and effective for comparable tumor complexity.

## Abstract

This single-center study evaluates two energy devices used during robotic-assisted partial nephrectomy (RAPN): a robotic vessel sealer (VS) and a conventional robotic bipolar grasper. A total of 112 patients who underwent RAPN between 2023 and 2025 were retrospectively analyzed, with perioperative, oncologic, and postoperative outcomes compared between groups. Tumor size, RENAL nephrometry score, operative time, ischemia time, console time, and complication rates were similar, indicating comparable case complexity and no evident selection bias. The key finding was a statistically significant reduction in estimated blood loss in the VS group compared with the bipolar group, without differences in ischemia time or postoperative morbidity. Both devices demonstrated safety and effectiveness, but the VS provided superior hemostasis without improving overall operative efficiency. The authors conclude that while robotic VS may be advantageous in cases where minimizing blood loss is critical, bipolar graspers remain a reliable and cost-effective alternative. Larger multicenter and randomized studies are needed to assess long-term renal function and cost-effectiveness.

Background: Robotic-assisted partial nephrectomy (RAPN) is widely used for nephron-sparing surgery. Vessel sealing technologies play a crucial role in these procedures, influencing ischemia time, blood loss, and surgical outcomes. This study compares the efficacy and safety of using a robotic vessel sealer (VS) versus conventional bipolar energy in robotic partial nephrectomy. Methods: A retrospective analysis was conducted on patients (n = 112) undergoing RAPN using either a robotic VS or bipolar energy grasper between 2023 and 2025. Parameters analyzed included ischemia time, estimated blood loss (EBL), postoperative complications, and functional outcomes. Statistical comparisons were performed to assess differences in perioperative and postoperative metrics. Results: The vessel sealer (VS) group (n = 54) had significantly lower blood loss (40 mL vs. 132.5 mL, p = 0.037) than the bipolar group (n = 58). Ischemia time was similar (24.5 min vs. 20.46 min, p = 0.444). No significant differences were found in operative time, console time, docking time, or postoperative complications (p > 0.05). The tumor diameter (CT: 28.38 mm vs. 25.5 mm, p = 0.655; pathology: 2.34 cm vs. 1.96 cm, p = 0.375) and Radius–Exophytic/Endophytic–Nearness to collecting system or sinus–Anterior/posterior–Location relative to polar lines (RENAL) score (7.00 vs. 6.17, p = 0.202) were slightly higher in the bipolar group but not statistically significant. Conclusions: Both techniques seem to be used for tumors of comparable size and complexity, suggesting no strong selection bias. Future research should prioritize randomized controlled trials assessing long-term renal function, cost-effectiveness, and potential refinements of robotic vessel sealing technology. A broader, multicenter analysis could provide further insight into optimal device selection for robotic partial nephrectomy.