Descriptive analysis of initial experience with partial nephrectomy and retroperitoneal organ surgery using supine...

This study aimed to evaluate the feasibility, safety, and perioperative outcomes of the supine anterior retroperitoneal approach (SARA) using the da Vinci single-port (SP) robotic system for partial nephrectomy (PN) and retroperitoneal organ surgeries.

From December 2023 to December 2024, 35 retroperitoneal surgeries, including 25 PN and 10 other procedures (e.g., adrenalectomy, pyeloplasty, ureterectomy), were performed via SARA with the da Vinci SP system by a single surgeon. Patient demographics, operative details, renal function, and postoperative recovery parameters were analyzed.

The mean patient age was 60.3 years, with a body mass index of 24.8. The mean operative time was 203.1 minutes, and mean console time was 141.9 minutes. Estimated blood loss was 330.4 mL, with minimal hemoglobin drop and renal function decline. No conversions to open surgery or major complications were observed. Postoperative pain was mild (mean numeric rating scale 2.5), and bowel function returned within 1.7 days. Tumor size averaged 3.5 cm, with most being clear cell carcinoma. SARA proved effective for upper and lower pole masses, and for adrenal or ureteral surgeries.

The SARA technique using the da Vinci SP robotic system is a safe and feasible approach for PN and various retroperitoneal procedures. It allows for minimal invasiveness, low complication rates, and rapid recovery. Further studies are needed to validate these findings and define the learning curve.