Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Purpose</jats:bold>: The retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses additional surgical challenge due to the special location and poor tumor exposure. A novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN was developed, and its efficacy was assessed in a consecutive case series.<jats:bold>Methods</jats:bold>: From April 2017 to April 2019, a total of 24 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique was applied in all these cases, which specialized in improving the exposure of posterior hilar tumor by rotating the kidney ventrally. Perioperative data was analyzed to evaluate the efficacy of this technique.<jats:bold>Results</jats:bold>: The mean tumor size was 4.3 ± 1.7 cm (range 2.5-8 cm), and the median R.E.N.A.L score was 9 (range 7-12). All the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The mean operation time was 80 ± 24 min, the mean estimated blood loss was 104 ± 65 ml, and the warm ischemia time was 17.4 ± 6.6 min. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases.<jats:bold>Conclusion</jats:bold>: Kidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient method for the management of posterior hilar tumor.<jats:bold>KEYWORDS</jats:bold>: robotic surgery; partial nephrectomy; posterior hilar tumor; retroperitoneal approach; kidney rotation</jats:p>