Intraoperative Traction Force During Robot-Assisted Partial Nephrectomy Using the da Vinci 5 System: Clinical Determinants from a Single-Center Study.

PURPOSE: To evaluate intraoperative traction force during robot-assisted partial nephrectomy (RAPN) using a force-feedback-enabled robotic platform and to identify clinical factors associated with increased force application. MATERIALS AND METHODS: This retrospective study included 20 consecutive patients who underwent RAPN using the da Vinci 5 system. Intraoperative force data were collected using force feedback-enabled instruments. Primary force metrics included average force and the proportion of time above 6.5 N measured using ProGrasp forceps. Associations between clinical variables and force metrics were assessed using correlation analysis, group comparisons, and multivariable linear regression. RESULTS: The median average force measured using ProGrasp forceps was 2.15 N, and the median time above 6.5 N was 2.8%. Tumor size showed a modest positive correlation with average force (r = 0.35) and time above 6.5 N (r = 0.31). In group comparisons, both force metrics were significantly higher in male patients, in the retroperitoneal approach, and in left-sided tumors. In multivariable analysis, the retroperitoneal approach was identified as an independent predictor of increased average force (β = 1.24, 95% CI: 0.60-1.88, p < 0.001) and increased time above 6.5 N (β = 0.25, 95% CI: 0.06-0.44, p = 0.011). CONCLUSIONS: Intraoperative traction force during RAPN is significantly influenced by surgical approach, with higher forces observed in the retroperitoneal approach. Force metrics derived from the ProGrasp forceps may provide an objective measure of intraoperative traction and may reflect differences in technical demands between surgical approaches.