Robotic retroperitoneal partial nephrectomy

Abstract

Purpose of review: Robotic-assisted renal surgery is being increasingly utilized; however, the majority of these are performed via a transperitoneal approach. Retroperitoneal robotic surgery is a relatively new technique allowing direct access to the posterolateral surface of the kidney, as well as posterior hilar structures. In this review, we summarize the most recent publications and review our experience of robotic retroperitoneal partial nephrectomy.

Recent findings: The retroperitoneal approach has been successfully applied to robotic partial nephrectomy. The current series find this approach ideal for posterior and lateral renal masses, and technically feasible with the advances in robotic technology. The retroperitoneal approach has been shown to decrease operative times, narcotic need, and permit quicker return of bowel function. Furthermore, there does not appear to be any increase in perioperative complications using this approach. Since 2006, we have treated 68 patients using this approach. The mean age was 58.9 years, and mean preoperative tumor size 2.5 cm (range 1-5 cm). Mean operative and warm ischemia time were 125 min and 20.7 min, respectively. The majority of patients had renal cell carcinoma, with a 4.4% positive margin rate. The most common complication was an arterial pseudoaneurysm in 3 (4.4%) patients. The limited data using this technique offer an encouraging outlook on robotic retroperitoneal partial nephrectomy. The retroperitoneal approach permits direct access to the renal hilum, no need for bowel mobilization, and excellent visualization for posteriorly located renal masses.