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Retroperitoneal Robot-Assisted Partial Nephrectomy (rRAPN): Surgical Technique and Review

A Correction to this article was published on 26 June 2021

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Abstract

Purpose of Review

We aim to offer a description of the surgical technique and to review the current state retroperitoneal robot-assisted partial nephrectomy (rRAPN).

Recent Findings

Partial nephrectomy is the standard treatment for localized kidney tumours. rRAPN is especially useful for kidney tumours of posterior location. It offers advantages such as direct access to the renal artery and no need for bowel mobilization. The disadvantages are the small working space and the less familiar anatomical landmarks. It is a reproducible technique that achieves similar oncological and functional results to the more traditional transperitoneal route (tRAPN). High-quality randomized studies are needed to ascertain the role of new technologies as modern high-flow insufflation systems, intracavitary ultrasound, 3D planning, and augmented reality (AR), in the performance of this operation.

Summary

rRAPN is especially useful for kidney tumours of posterior location. Robotic surgeons ideally should become familiar with both approaches, transperitoneal or retroperitoneal.

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Change history

References

  1. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: the 2019 update. Eur Urol. 2019;75:799–810.

    Article  Google Scholar 

  2. Casale P, Lughezzani G, Buffi N, Larcher A, Porter J, Mottrie A, et al. Evolution of robot-assisted partial nephrectomy: techniques and outcomes from the transatlantic robotic nephron-sparing surgery study group. Eur Urol. 2019;76:222–7.

    Article  Google Scholar 

  3. Hu JC, Treat E, Filson CP, McLaren I, Xiong S, Stepanian S, et al. Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: a multicenter study. Eur Urol. 2014;66:542–9.

    Article  Google Scholar 

  4. Ghani KR, Porter J, Menon M, Rogers C. Robotic retroperitoneal partial nephrectomy: a step-by-step guide: robotic retroperitoneal partial nephrectomy. BJU Int. 2014;114:311–3.

    Article  Google Scholar 

  5. Patel M, Porter J. Robotic retroperitoneal partial nephrectomy. World J Urol. 2013;31:1377–82.

    Article  Google Scholar 

  6. Pavan N, Derweesh I, Hampton LJ, White WM, Porter J, Challacombe BJ, et al. Retroperitoneal robotic partial nephrectomy: systematic review and cumulative analysis of comparative outcomes. J Endourol. 2018;32:591–6.

    Article  Google Scholar 

  7. Gaur DD, Agarwal DK, Purohit KC. Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol. 1993;149:103–5.

    CAS  Article  Google Scholar 

  8. Porreca A, D'Agostino D, Dente D, Dandrea M, Salvaggio A, Cappa E, et al. Retroperitoneal approach for robot-assisted partial nephrectomy: technique and early outcomes. Int Braz J Urol. 2018;44:63–8.

    CAS  Article  Google Scholar 

  9. Dell'Oglio P, De Naeyer G, Xiangjun L, Hamilton Z, Capitanio U, Ripa F, et al. The impact of surgical strategy in robot-assisted partial nephrectomy: is it beneficial to treat anterior tumours with transperitoneal access and posterior tumours with retroperitoneal access? Eur Urol Oncol 2019;S2588931118302189.

  10. Arora S, Heulitt G, Menon M, Jeong W, Ahlawat RK, Capitanio U, et al. Retroperitoneal vs transperitoneal robot-assisted partial nephrectomy: comparison in a multi-institutional setting. Urology. 2018;120:131–7.

    Article  Google Scholar 

  11. Stroup SP, Hamilton ZA, Marshall MT, Lee HJ, Berquist SW, Hassan AS, et al. Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for pentafecta perioperative and renal functional outcomes. World J Urol. 2017;35:1721–8.

    Article  Google Scholar 

  12. Annino F, Topazio L, Autieri D, Verdacchi T, De Angelis M, Asimakopoulos AD. Robotic partial nephrectomy performed with Airseal versus a standard CO2 pressure pneumoperitoneum insufflator: a prospective comparative study. Surg Endosc. 2017;31:1583–90.

    Article  Google Scholar 

  13. Cacciamani GE, Shakir A, Tafuri A, Gill K, Han J, Ahmadi N, et al. Best practices in near-infrared fluorescence imaging with indocyanine green (NIRF/ICG)-guided robotic urologic surgery: a systematic review-based expert consensus. World J Urol. 2020;38:883–96.

    Article  Google Scholar 

  14. Sentell KT, Ferroni MC, Abaza R. Near-infrared fluorescence imaging for intraoperative margin assessment during robot-assisted partial nephrectomy. BJU Int. 2020;126:259–64.

    Article  Google Scholar 

  15. Rogers CG, Laungani R, Bhandari A, Krane LS, Eun D, Patel MN, et al. Maximizing console surgeon independence during robot-assisted renal surgery by using the fourth arm and Tile pro. J Endourol. 2009;23:115–21.

    Article  Google Scholar 

  16. Abaza R, Gerhard RS, Martinez O. Feasibility of adopting retroperitoneal robotic partial nephrectomy after extensive transperitoneal experience. World J Urol. 2020;38:1087–92.

    CAS  Article  Google Scholar 

  17. Anderson BG, Wright AJ, Potretzke AM, Figenshau RS. Retroperitoneal access for robotic renal surgery. Int Braz J Urol. 2018;44:200–1.

    Article  Google Scholar 

  18. McLean A, Mukherjee A, Phukan C, Veeratterapillay R, Soomro N, Somani B, et al. Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualized approach. A systematic review and meta-analysis. J Robot Surg. 2020;14:1–9.

    Article  Google Scholar 

  19. Mittakanti HR, Heulitt G, Li H-F, Porter JR. Transperitoneal vs. retroperitoneal robotic partial nephrectomy: a matched-paired analysis. World J Urol. 2020;38:1093–9.

    Article  Google Scholar 

  20. Choi CI, Kang M, Sung HH, Jeon HG, Jeong BC, Jeon SS, et al. Comparison by pentafecta criteria of transperitoneal and retroperitoneal robotic partial nephrectomy for large renal tumors. J Endourol. 2020;34:175–83.

    Article  Google Scholar 

  21. Choo SH, Lee SY, Sung HH, Jeon HG, Jeong BC, Jeon SS, et al. Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisons by nephrometry scores. World J Urol. 2014;32:1523–9.

    Article  Google Scholar 

  22. Malki M, Oakley J, Hussain M, Barber N. Retroperitoneal robot-assisted partial nephrectomy in obese patients. J Laparoendoscopic Adv Surg Tech. 2019;29:1027–32.

    Article  Google Scholar 

  23. Cacciamani GE, Okhunov Z, Meneses AD, Rodriguez-Socarras ME, Rivas JG, Porpiglia F, et al. Impact of three-dimensional printing in urology: state of the art and future perspectives. A Systematic Review by ESUT-YAUWP Group. Eur Urol. 2019;76:209–21.

    Article  Google Scholar 

  24. Borgmann H, Rodríguez Socarrás M, Salem J, Tsaur I, Gomez Rivas J, Barret E, et al. Feasibility and safety of augmented reality-assisted urological surgery using smartglass. World J Urol. 2017;35:967–72.

    CAS  Article  Google Scholar 

  25. Shirk JD, Thiel DD, Wallen EM, Linehan JM, White WM, Badani KK, et al. Effect of 3-Dimensional virtual reality models for surgical planning of robotic-assisted partial nephrectomy on surgical outcomes: a randomized clinical trial. JAMA Netw Open. 2019;2:e1911598.

    Article  Google Scholar 

  26. Porpiglia F, Checcucci E, Amparore D, Piramide F, Volpi G, Granato S, et al. Three-dimensional augmented reality robot-assisted partial nephrectomy in case of complex tumours (PADUA ≥10): a new intraoperative tool overcoming the ultrasound guidance. Eur Urol. 2020;78:229–38.

    Article  Google Scholar 

  27. Weizer AZ, Palella GV, Montgomery JS, Miller DC, Hafez KS. Robot-assisted retroperitoneal partial nephrectomy: technique and perioperative results. J Endourol. 2011;25:553–7.

    Article  Google Scholar 

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Correspondence to Moises Rodríguez Socarrás.

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Conflict of Interest

Moises Rodríguez Socarrás, Javier Reinoso Elbers, Juan Gómez Rivas, Ana Maria Autran, Francesco Esperto, Leonardo Tortolero, Diego M Carrion, and Fernando Gómez Sancha each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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The original online version of this article was revised: The author name "Diego Carrion" was incorrect.

This article is part of the Topical Collection on Kidney Diseases

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Socarrás, M.R., Elbers, J.R., Rivas, J.G. et al. Retroperitoneal Robot-Assisted Partial Nephrectomy (rRAPN): Surgical Technique and Review. Curr Urol Rep 22, 33 (2021). https://doi.org/10.1007/s11934-021-01051-z

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  • DOI: https://doi.org/10.1007/s11934-021-01051-z

Keywords

  • Retroperitoneal robotic surgery
  • Robotic partial nephrectomy
  • Kidney cancer
  • Kidney tumour
  • Retroperitoneal robot-assisted partial nephrectomy