Retroperitoneal robotic kidney surgery

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, posteriorly 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 posteriorly located tumors and for patients who have had previous surgery. A four-trocar configuration is used with trocars placed between the 12th rib and the iliac crest. The robot is docked over the patient’s head parallel to the spine. The psoas muscle and Gerota’s fascia are the major landmarks used to maintain orientation during dissection. Retroperitoneal robotic partial nephrectomy is a safe and reproducible approach to minimally invasive partial nephrectomy. The retroperitoneal approach is ideally suited to posterior and lateral tumors, eliminating the need to rotate the kidney. The limitations of the retroperitoneal space do not prohibit use of the robot.