V11-01: Retroperitoneal robotic partial nephrectomy: a step-by-step guide

Video

Introductions and Objectives
The retroperitoneal (RP) approach to robotic partial nephrectomy (RPN) is ideal for posterior tumors which would otherwise require complete mobilization if using a transperitoneal technique. Due to the smaller working space, the RP approach can be challenging. In this video we describe a step-by-step guide for successful implementation of retroperitoneal RPN.

Methods
The patient is placed in the full flank position and the table fully flexed to increase the space between the 12th rib and iliac crest. To identify optimal port placement, the iliac crest, ribs and axillary lines are marked. Access to the RP space is created using a balloon dilating device (PDS System, Covidien, Mansfield, MA). Ports include a 12 mm camera port, two robotic ports and a 12 mm assistant port placed in the anterior axillary line cephalad to the anterior superior iliac spine and 7–8 cm caudal to the ipsilateral robotic port.

Results
Positioning and port placement strategies for successful technique include: (1) Docking robot directly over the patient’s head parallel to the spine (2) Incision for camera port one finger breadths space above the iliac crest, lateral to the triangle of Petit. (3) Seldinger technique insertion of kidney shaped balloon dilator into RP space (4) Maximising distance between all ports (5) Ensuring the camera arm is placed in the outer part of the "sweet spot".

Conclusions
Since refining our technique, the RP approach to RPN has become considerably easier. The RP approach permits direct access to the renal hilum, no need for bowel mobilization and excellent visualization for posteriorly located renal tumors.

Funding: none