Anatomical tour: Single-port retroperitoneal partial nephrectomy

The single-port (SP) robotic platform has reshaped minimally invasive renal surgery, and the retroperitoneal low anterior access (LAA) approach has emerged as a versatile, increasingly favored technique. As adoption grows, surgeons need a detailed, anatomically grounded account of the operative steps and decision points unique to SP retroperitoneal partial nephrectomy, an account that current literature does not provide.

The advent of the da Vinci SP platform has reduced the influence of tumor location on surgical approach selection. Whereas anterior, posterior, hilar, and polar tumors often dictated whether a transperitoneal or retroperitoneal approach was chosen in multiport robotic surgery, contemporary SP series have demonstrated the feasibility of treating a broad spectrum of renal tumor locations through a retroperitoneal approach. The ability to work effectively within confined spaces allow access to anterior, posterior, hilar, upper-pole, and lower-pole masses from a single access site and patient position. These developments have expanded the applicability of retroperitoneal surgery and has facilitated its adoption among trainees and surgeons with previous transperitoneal experience. As a result, traditional paradigms that relied heavily on tumor location for operative planning are being increasingly reconsidered.

A retroperitoneal-first strategy with the SP platform simplifies access, shortens setup time, and broadens applicability across tumor locations, supporting its expanding role in nephron-sparing surgery. Comparative and long-term outcome data are still needed to refine patient selection.