Modified internal traction technique for improved exposure in retroperitoneal robot-assisted partial nephrectomy for...

Retroperitoneal robot-assisted partial nephrectomy (rRAPN) provides direct access to dorsal renal hilar tumors, yet exposure remains limited by their proximity to renal vessels and the collecting system. This study aimed to evaluate the feasibility and efficacy of an internal traction technique (ITT) as a technical refinement for rRAPN in patients with dorsal hilar tumors. This retrospective comparative cohort included 126 patients with dorsal hilar tumors who underwent rRAPN between November 2019 and December 2025. Suture-mediated renal traction was used in the ITT group (n = 63), which was compared with a conventional technique group (n = 63). Outcomes included warm ischemia time (WIT), estimated blood loss (EBL), operative time, postoperative recovery, and renal function. No patient required conversion to radical nephrectomy or open surgery. ITT was associated with shorter median WIT (17.00 [IQR, 16.00-18.50] vs. 21.00 [IQR, 18.00-24.00] min; P = 0.002) and lower mean EBL (116.48 ± 48.06 vs. 140.16 ± 42.87 mL; P = 0.004). Postoperative hospital stay and renal function were comparable between groups. All surgical margins were negative. Three minor intraoperative complications occurred and were controlled during surgery. One Clavien-Dindo grade II infection occurred in the conventional group. No recurrence or metastasis was documented within 6 months postoperatively. The internal traction technique facilitates exposure during rRAPN for anatomically challenging dorsal hilar tumors. Its use was associated with shorter WIT and modestly lower EBL, without an observed increase in perioperative complications.