Retroperitoneal Robotic Partial Nephrectomy
摘要
Partial nephrectomy (PN) is the preferred treatment for the removal of renal masses 4 cm or less, and the minimally invasive approach to PN is now considered the standard of care. While both laparoscopic and robotic PN are reproducible and feasible, the robotic technique provides the benefits of 3-D visualization and increased instrument dexterity, allowing the removal of more complex renal masses. However, the robotic platform is large and requires space for robotic arm movement, and this has resulted in the application of the robot predominately through transperitoneal access. Despite the need for a greater working space for robotic PN, techniques for applying the robot directly into the retroperitoneal space have been developed and standardized. The retroperitoneal approach has the distinct advantages of direct access to the renal artery, avoiding bowel manipulation, and sequestering renal bleeding to the retroperitoneal space. It is ideal for removing posterior and lateral masses and accessing the obese patient. As the robotic platform has improved and evolved, so has our technique for retropertioneal PN. Our objective is to provide a detailed illustration of our surgical approach to robotic retroperitoneal partial nephrectomy.