Low anterior access for single port (SP) retroperitoneal partial nephrectomy: Technique and outcomes

Abstract

Introduction: Single Port (SP) robotic partial nephrectomy (RPN) can be performed via retroperitoneal and transperitoneal approach. We aim to describe low anterior access (LAA) with outcomes and compare outcomes to lateral flank approach (LFA). Materials and Methods: We performed a retrospective study of patients who underwent SP retroperitoneal RPN from 2018 -2023 as part of a large multi-institute collaboration (SPARC). Baseline demographic, clinical, tumor-specific characteristics, and perioperative outcomes were compared using χ2, t-test, Fisher exact test, and Mann–Whitney U test. Multivariable analyses were conducted using robust and logistic regressions. Results: A total of 70 patients underwent SP retroperitoneal RPN, with 44 undergoing LAA. The LAA group exhibited significantly lower median RENAL scores (8 vs. 5, p < 0.001) and more varied tumor locations (p = 0.002). When controlling for other variables, LAA was associated with shorter ischemia time (p = 0.005) than LFA, but there was no significant difference in operative time (p = 0.348) and length of stay (p = 0.122). Conclusion: Both LAA and LFA are acceptable approaches for SP retroperitoneal RPN with comparable perioperative outcomes.

Keywords

• Single port
• Robotics
• Partial nephrectomy
• Surgical access
• Patient positioning