Can robotic partial nephrectomy replace the ablative techniques in the treatment of small renal masses?

With the advent of modern, improved abdominal imaging techniques, the ratio of incidentally discovered renal tumors increased 50-60% [1]. For small renal masses (SRM), the options are surgical removal, ablative treatment, or active surveillance, depending on the tumor characteristics as well as patient status and preference [2-5]. Minimaly invasive ablative techniques, such as cryoor radio-frequency ablation of SRM, proved to have very good surgical and oncological results for patients unfit for surgery or for those who do not want surgical treatment. However, there are very strict criteria [2, 3, 4] for the ablative technique, significantly reducing the number of the appropriate candidates for this treatment. The paper published by Harris and coworkers [6] aims to be a plea towards the shifting from ablative techniques to robotic partial nephrectomy. I congratulate the authors for their paper because it opens a new direction: they can do it, having an impressive experience with robotic urology in their center. The results of the 26 cases – excellent, as of the whole group – can be good arguments for their purpose, but in fact, as the authors acknowledge, they are not strong enough due to many bias factors. The Can robotic partial nephrectomy replace the ablative techniques in the treatment of small renal masses?