Robotic partial nephrectomy (RPN) has increasingly been applied to the treatment of small renal masses. Because of space limitations and the size of the robot at the patient side, the standard approach to RPN has been transperitoneal. However, posterior located tumors are difficult to approach transperitoneally, and require the kidney to be completely mobilized and flipped medially. Retroperitoneal robotic partial nephrectomy is an alternative technique ideally suited for posterior located tumors and for patients who have had previous surgery. The approach eliminates the need to rotate the kidney and avoids manipulation of the intestines. Consequently, patients are able to eat and leave the hospital sooner in our experience. The evolution of the daVinci robot has facilitated the retroperitoneal approach to partial nephrectomy by allowing the robotic arms to be placed closer and permitting more range of movement. Retroperitoneal robotic partial nephrectomy is a safe and reproducible approach to minimally invasive partial nephrectomy.
1. Understand the indications for retroperitoneal robotic partial nephrectomy
2. Identify the retroperitoneal landmarks, port configuration and docking for retroperitoneal robotic partial nephrectomy
3. Understand the techniques for creating and optimizing the retroperitoneal space