Retroperitoneal Robotic Procedures

Abstract

The robotic-assisted retroperitoneal approach to the kidney and ureter in infants and children is more challenging than the transperitoneal approach. However, once familiar with it, it provides the surgeon with almost the same options as the transperitoneal approach. In addition the risk of damage of intra-abdominal organs is minimal and urine leakage from a ureteric anastomosis is self-limiting. The most important step in the retroperitoneal access is the correct port placement with the camera port 1.5 cm above the iliac spine. The retroperitoneum is dilated with 200–300 mL air through a balloon catheter. The instrument ports are subsequently located medially and laterally at the same level. A 5 mm assistant port in the iliac fossa is optional. The robot is docked from a cranial position. Gerota’s fascia is widely opened in a vertical manner close to the psoas muscle making the kidney falling medially. From this point the procedures do not differ significantly from the transabdominal approach.