Robotic retroperitoneal partial nephrectomy: rediscovering a proven approach in the era of minimally invasive surgery

Renal cell carcinoma (RCC) accounts for approximately 3% of all malignancies, with its incidence steadily increasing due to the widespread use of abdominal imaging techniques and the improved detection of asymptomatic renal masses. Traditionally, radical nephrectomy (RN) was considered the gold standard for the surgical treatment of renal tumors. However, over the past decades, advancements in minimally invasive surgical techniques have led to a paradigm shift in favor of nephron-sparing approaches, particularly partial nephrectomy (PN). The introduction of robot-assisted partial nephrectomy (RAPN) has further refined this approach by enhancing surgical precision, reducing invasiveness, and improving outcomes in terms of renal function preservation. This manuscript describes a standardized and reproducible technique for retroperitoneal robot-assisted partial nephrectomy (rRAPN) using the da Vinci Xi system, illustrated through two representative cases involving right- and left-sided posterior renal tumors. Key steps in the procedure included the creation of a retroperitoneal space, identification of crucial anatomical structures, excision of the tumor using a clamp-less technique, the suture of the resection bed and the application of hemostatic agents to control bleeding. Postoperative care focused on monitoring renal function, detecting complications, and ensuring optimal recovery. Both patients had successful outcomes, with minimal blood loss, stable renal function, and negative surgical margins. Furthermore, there were no postoperative complications, and both patients were discharged within 4 or 5 days of the procedure. Retroperitoneal access offers distinct advantages, particularly for patients with previous abdominal surgeries or for those with tumors located in the posterior renal region. This approach provides oncological and functional outcomes that are comparable to transperitoneal techniques while reducing perioperative morbidity. The detailed steps outlined in this study aim to facilitate the broader adoption of rRAPN, emphasizing its potential to improve the management of select renal neoplasms. By standardizing this technique, we aim to further refine the role of retroperitoneal robot-assisted surgery in treating RCC and promote its integration into routine clinical practice.