Robotic Retroperitoneal Versus Transperitoneal Partial Nephrectomy: Outcomes and Learning Curve

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic retroperitoneal renal surgery was introduced in 2018.
• Clinical criteria for choosing between transperitoneal and retroperitoneal access are unclear.
• This study aimed to define criteria for selecting the renal approach site.

Purpose of the Study:

• To explore the learning curve of robotic retroperitoneal renal surgery.
• To assess the impact of surgical access site on clinical outcomes.
• To identify preoperative clinical criteria for choosing between transperitoneal and retroperitoneal renal surgery.

Main Methods:

• Retrospective analysis of 107 patients undergoing robotic renal tumor surgery (June 2018 - March 2022).
• Comparison of 86 patients with transperitoneal access versus 21 patients with retroperitoneal access.
• Evaluation of preoperative data (BMI, PADUA score) and intraoperative/postoperative outcomes (blood loss, clamping time, renal function, learning curve).

Main Results:

• Retroperitoneal approach demonstrated significantly shorter operation times (p=0.015).
• No significant differences observed in operation-specific variables, PADUA score, or hilar clamping time between groups.
• The learning curve for retroperitoneal access showed a notable difference based on surgeon experience.

Conclusions:

• Surgeons with prior robotic renal surgery experience can master the retroperitoneal approach without increased morbidity.
• The PADUA score is recommended as a suitable preoperative criterion for selecting the renal approach site.