Hypothesis / aims of study
Background:
Robot-assisted laparoscopic partial nephrectomy via a retroperitoneal approach (RAPN) is increasingly utilized for the management of renal tumors, particularly when posterior access is advantageous. We present our initial experience with this technique.
Objective:
To evaluate the feasibility, perioperative outcomes, and early oncological results of RAPN performed via a retroperitoneal approach.
Study design, materials and methods
Methods:
We conducted a retrospective review of consecutive patients scheduled for RAPN. De-mographics, tumor characteristics, operative details, and postoperative outcomes were ana-lyzed.
Results
Results:
Twenty-five patients were scheduled for RAPN. In one case, retroperitoneal access was not achievable due to a hematoma and fragile peritoneum. Among the remaining 24 patients (71% male, median BMI 28 [22–35]), the median tumor size was 2.6 cm (1.2–5 cm). Tumors were predominantly posterior (n=17), with 14 located caudally.
Median operative time was 144 minutes (86–238), warm ischemia time 17 minutes (6–29), and blood loss 50 ml (0–350). Histopathology showed benign tumors in 4 patients. All 18 renal cell carcinomas had negative surgical margins.
Interpretation of results
Postoperative complications occurred in 7 out of 24 patients (29%) following the procedure. One patient experienced severe postoperative pain that necessitated an extended hospital stay for adequate pain control and monitoring. Infectious complications were documented in four patients; all cases were managed conservatively with intravenous antibiotic therapy, with no need for surgical intervention or readmission. In two patients, significant postoperative bleeding was encountered. Both cases required interventional radiologic management with selective arterial coil embolization to achieve hemostasis. These bleeding events were associated with centrally located renal tumors, measuring 3.5 cm and 4.7 cm in maximal diameter, respectively, suggesting a potential correlation between tumor location and risk of hemorrhagic complications. All patients recovered fully following appropriate management, and there were no procedure-related mortalities.
Concluding message
Conclusion:
Robot-assisted partial nephrectomy (RAPN) performed via a retroperitoneal approach has proven to be a feasible and safe surgical option, demonstrating favorable operative metrics and encouraging short-term oncological outcomes. Our experience with 34 consecutive cases shows that, with increased familiarity and refinement of technique, the learning curve improves significantly after the initial five procedures. Notably, consultation and operative planning time has progressively decreased to under one hour, reflecting growing efficiency and surgical expertise within the team.
While the overall complication rate remains within acceptable limits, particular attention must be paid to the risk of postoperative bleeding, especially in cases involving larger or centrally located renal tumors. In our cohort, hemorrhagic complications requiring coil embolization were exclusively associated with centrally situated lesions exceeding 3.5 cm, underscoring the importance of individualized preoperative risk assessment and meticulous intraoperative hemostasis in such cases.
In summary, the retroperitoneal approach to RAPN offers a minimally invasive yet effective alternative to traditional techniques, with a manageable complication profile. Ongoing evaluation and long-term follow-up are essential to further validate oncological durability and functional outcomes.