Single port robotic partial nephrectomy via a retroperitoneal approach

In recent years, the introduction of the Da Vinci Single Port (SP) robotic platform has opened new doors for the treatment of localized renal masses. This technology, particularly when utilized via a regionalized retroperitoneal (RP) approach, offers several distinct advantages that may improve patient recovery. These advantages include easier access to both anterior and posterior renal tumors, avoidance of the peritoneal cavity with complicating adhesions, and simplified supine positioning, potentially reducing the risk of musculoskeletal or nerve injuries. Yet, the learning curve for RP surgery remains steep due to the unfamiliarity of many surgeons with the RP endoscopic perspective and ergonomic challenges of the SP robot. Given this relatively new technology and its growing availability in many institutions, most surgeons remain early in their evolution of performing SP partial nephrectomy (PN). Herein, we discuss our technique for performing SP PN via an RP approach, including port access, anatomic considerations, and operative techniques. Our hope is to familiarize readers with this powerful approach and smooth out early pitfalls during the learning curve.