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.
Similar content being viewed by others
Change history
26 June 2021
A Correction to this paper has been published: https://doi.org/10.1007/s11934-021-01058-6
References
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.
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.
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.
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.
Patel M, Porter J. Robotic retroperitoneal partial nephrectomy. World J Urol. 2013;31:1377–82.
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.
Gaur DD, Agarwal DK, Purohit KC. Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol. 1993;149:103–5.
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.
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.
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.
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.
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.
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.
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.
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.
Abaza R, Gerhard RS, Martinez O. Feasibility of adopting retroperitoneal robotic partial nephrectomy after extensive transperitoneal experience. World J Urol. 2020;38:1087–92.
Anderson BG, Wright AJ, Potretzke AM, Figenshau RS. Retroperitoneal access for robotic renal surgery. Int Braz J Urol. 2018;44:200–1.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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
Rights and permissions
About this article
Cite this article
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
Accepted:
Published:
DOI: https://doi.org/10.1007/s11934-021-01051-z