LAUSR

INTRODUCTION AND OBJECTIVE: To present the feasibility and technical details of robot-assisted single port partial nephrectomy with a retroperitoneal approach, using da Vinci SP platform. METHODS: Between April and July 2019, 2 patients (1 male) with renal mass (both right side) underwent robot-assisted single port retroperitoneal partial nephrectomy. Both patients had organ confined disease with lower pole 24 and 25 mm renal masses (Nephrometry score: 4p and 6p). Patients were positioned in 90 degree flank position and a 30 mm transverse incision was made between the 12th rib and the iliac crest at the level of the mid axillary line. The retroperitoneal space is initially identified and created by digital exploration, followed by balloon dilation to create an appropriate working space. The inner ring of the alexis wound retractor was inserted in the retroperitoneal space, and the GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA) was assembled. A 25 mm multichannel robot port and a 12-mm accessory laparoscopic port were passed through the GelPOINT and the da Vinci SP Surgical System (Intuitive Surgical, Sunnyvale, CA) was docked. Standard partial nephrectomy with early unclamping technique and renorrhaphy in two layers was performed. The specimen was extracted through the trocar site and no drain was placed. RESULTS: Patients' age was 58 and 78 years. Both cases were completed successfully without any need for conversion, blood transfusion or intraoperative complications. Operative times were 155 and 240 minutes, with warm ischemia times of 26 and 29 minutes. Postoperative course was uneventful and patients were discharged after 26 and 42 hours of hospital stay. In-hospital analgesia included exclusively nonsteroidal anti-inflammatory drugs. Histopathological examination of specimens showed a 21 mm clear cell renal cell carcinoma and a 26 mm benign papillary adenoma, both with negative margins. CONCLUSIONS: Single-port partial nephrectomy through retroperitoneal approach is feasible in selected patients by Using da Vinci SP platform is feasible. This system has features such as double-jointed articulating robotic instruments and the articulating camera that allow to optimize the work in a smaller environment such the retroperitoneal space. With avoiding violation of the peritoneum, promising results regarding pain control, the need for opioid usage and postoperative recovery can be expected. Further comparative studies with larger sample and long-term follow-up data are recommended to corroborate these initial findings.