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Retroperitoneal access for robotic renal surgery.

Barrett G Anderson1, Alec J Wright1, Aaron M Potretzke1

  • 1Washington University School of Medicine, Division of Urology, Saint Louis, Missouri, USA.

International Braz J Urol : Official Journal of the Brazilian Society of Urology
|July 21, 2017
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Summary

Retroperitoneal robotic surgery offers a safe and effective alternative to the transperitoneal approach for renal procedures. This technique is associated with shorter operative times and reduced hospital stays, making it a viable option for selected patients.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Robotic Surgery

Background:

  • The transperitoneal approach is common for robotic renal surgery.
  • Retroperitoneal access presents an alternative with potential benefits.

Purpose of the Study:

  • To describe the institutional technique for retroperitoneal access in robotic renal surgery.
  • To outline the contemporary experience with this approach.

Main Methods:

  • Patients positioned in lateral decubitus.
  • Incision made inferior to the twelfth rib.
  • Retroperitoneal space dilated with a balloon access device, followed by trocar placement.

Main Results:

  • 177 patients underwent retroperitoneal robotic procedures (partial nephrectomies, pyeloplasties, radical nephrectomies).
  • Shorter operative times and decreased length of stay compared to the transperitoneal approach.
  • Robotic fourth arm utilized in all cases.

Conclusions:

  • Retroperitoneal robotic surgery avoids intraperitoneal injuries, beneficial for patients with prior abdominal surgery.
  • Offers a confined space that may minimize complications like urine leak.
  • A viable alternative for various renal procedures, associated with improved efficiency.