V04-05 Single Port Robotic Retroperitoneal Approach Allows for Both Anterior and Posterior Access to Tumors in Partial Nephrectomy

You have accessJournal of UrologyAdrenal/Renal Oncology I (V04)1 May 2024V04-05 SINGLE PORT ROBOTIC RETROPERITONEAL APPROACH ALLOWS FOR BOTH ANTERIOR AND POSTERIOR ACCESS TO TUMORS IN PARTIAL NEPHRECTOMY Nathan W. Cheng, Fahad Sheckley, Mubashir W. Billah, and Mutahar W. Ahmed Nathan W. ChengNathan W. Cheng , Fahad SheckleyFahad Sheckley , Mubashir W. BillahMubashir W. Billah , and Mutahar W. AhmedMutahar W. Ahmed View All Author Informationhttps://doi.org/10.1097/01.JU.0001009444.59519.d3.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Single-port robotics for partial nephrectomy has been recently shown to be feasible and with comparable outcomes to multiport (MP). Obtaining retroperitoneal access is more straightforward in SP than in MP. Traditionally, retroperitoneal partial nephrectomies have been more tailored toward posterior tumors. This video illustrates the ease of access to any tumor location on the kidney via the retroperitoneal approach with the SP robot, whether it be anterior or posteriorly located. METHODS: The retroperitoneal access is obtained by making the 2-3 inch skin incision along Langer's lines over the right or left lower quadrant, the external oblique fascial incision longitudinal to muscle aponeurosis fibers, splitting the internal oblique muscle fibers underneath, then bluntly dissecting through the transversalis fascia and sweeping the peritoneal contents medially to feel the belly of psoas muscle. After the access is obtained and the robot docked, the hilum is found to dissecting along the psoas muscle and identifying structures medially that will lead to the renal hilum, such as the ureter, gonadal vein, or vena cava. The renal artery is identified and dissected free. For anterior approach, the kidney is dropped from its anterior attachments of the perinephric fat and Gerota's fascia so that it falls to the psoas muscle. For posterior approach, the dissection continues along the psoas muscle floor so that the kidney continues to be suspended anteriorly by its attachments. The tumor excision and renorrhaphy can be done reproducibly with either approach. RESULTS: In our current series of SP retroperitoneal partial nephrectomies, there have been a total of 125 patients. 73 of them were done with arterial clamping, while 52 were done without arterial clamping. The mean nephrometry score was 8.3. The mean length of stay was 0.95 days. The mean operative time was 85 minutes, ranging from 55 to 230. The 30-day complication rate (greater than Clavien-Dindo II) was 2.4%, with two patients who required embolization for pseudoaneurysms and one patient requiring incisional hernia repair. CONCLUSIONS: The SP robot allows for ease of access into the retroperitoneum. Once in the retroperitoneum, because of the ability for the robot to navigate tighter spaces, any tumor location (anterior, posterior, or even hilar) can be approached. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e197 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nathan W. Cheng More articles by this author Fahad Sheckley More articles by this author Mubashir W. Billah More articles by this author Mutahar W. Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...