#174 Low Anterior Access for Retroperitoneal Single-Port Robotic Partial Nephrectomy Dr. J. Kaouk

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Dr. Jihad Kaouk

Abstract: Low Anterior Access for Retroperitoneal Single-Port Robotic Partial Nephrectomy

Objectives: To demonstrate the feasibility and early outcomes of robotic retroperitoneal par5al nephrectomy performed via a low anterior abdominal (or Pfannenstiel) incision using the purpose-built Single-Port (SP) robotic platform.

Materials & Methods: This video presents a case of retroperitoneal partial nephrectomy performed on a 69-year-old man with asymptomatic cT1a leD upper pole renal mass using the DaVinci SP robotic system. Direct retroperitoneal access was obtained via a 3.5cm low anterolateral abdominal incision. ADer incising the external oblique fascia, blunt dissection was performed to develop a space above the peritoneum for the insertion of the SP Access Port. Perioperative outcomes were evaluated for this patient and the additional three patients that constituted our initial series (n=4).

Results: The procedure was completed under general anesthesia without the need for conversion or additjonal ports. The operating time was 2.5 hours with a warm ischemia time of 25 minutes and an es5mated blood loss of 15mL. There were no intraoperative or postoperative complications. The patient was discharged 6.5 hours following the completion of surgery without requiring any opioid analgesia, both as an inpatient and on discharge. Similar outcomes were achieved in the other cases, with our technique being reproducible for anterior, posterior, and laterally-located tumors.

Conclusion: The improved manoeuvrability of the SP platform allowed for robotic retroperitoneal partial nephrectomy to be safely and effectively performed via a low anterior abdominal incision for any tumor location. The technique facilitated opioid-sparing enhanced postoperative recovery with all patients being discharged within 24 hours without any clinical sequelae.

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