V9-05: Retroperitoneal Access for Robotic Renal Surgery
Retroperitoneal access for robotic renal surgery is an effective alternative to the commonly used transperitoneal approach. We describe our contemporary experience and technique for attaining retroperitoneal access.
We outline our institutional approach to retroperitoneal access for the instruction of urologists at the beginning of the learning curve for this technique. The patient is placed in the lateral decubitus position. The first incision is made just inferior to the tip of the twelfth rib. After the lumbodorsal fascia is traversed, the retroperitoneal space is dilated with a round 10 millimeter AutoSuture (Covidien, Mansfield, MA) balloon access device. The following trocars are used: A 130 millimeter Kii balloon trocar (Applied Medical, Rancho Santa Margarita, CA), three robotic, and one assistant. Key landmarks for the access and dissection are detailed.
177 patients underwent a retroperitoneal robotic procedure from 2007 to 2015. Procedures performed include 158 partial nephrectomies, 16 pyeloplasties, and three radical nephrectomies. When compared with the transperitoneal approach, the retroperitoneal approach is associated with shorter operative times and decreased length of stay.
Retroperitoneal robotic surgery may confer several advantages. In patients with previous abdominal surgery or intra-abdominal conditions, the retroperitoneum can be safely accessed while avoiding intraperitoneal injuries. The retroperitoneum also provides a confined space that may minimize the sequelae of potential complications including urine leak. Moreover, at our institution, retroperitoneal robotic surgery is associated with shorter operative times and a decreased length of stay when compared with the transperitoneal approach. In selected patients, the retroperitoneal approach is a viable alternative to the transperitoneal approach for a variety of renal procedures.