Supplementary file 1_Membrane anatomy-guided robot-assisted partial nephrectomy: operational definition and association with warm ischemia time in a single-surgeon cohort.docx

This study evaluates a stepwise membrane anatomy-guided pathway and its association with warm ischemia time (WIT) and clamping-phase efficiency, controlling for surgical experience and temporal confounding.</p>Methods<p>We evaluated 151 consecutive RAPN cases (30 conventional vs. 121 membrane anatomy-guided) performed by a single-center, single-surgeon cohort using the da Vinci Xi System (2022–2025).

Multivariable linear regression with HC3 robust standard errors was performed to assess the primary outcome (WIT), adjusting for clinical covariates and nonlinear cumulative case sequence (natural cubic spline, df = 3). Chronology-adjusted sensitivity analyses and propensity-score overlap weighting were conducted.</p>Results<p>Despite substantial chronological overlap between pathways, the membrane-guided pathway was independently associated with a 4.05-min reduction in mean WIT (95% CI -6.82 to -1.28; P = 0.004) without compromising surgical margin safety.