Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

Abstract

Introduction Robotic nephron-sparing surgery is traditionally performed via a transperitoneal (TP) approach. However, the retroperitoneal (RP) approach has gained popularity, particularly for posterolateral renal masses. The RP approach is associated with shorter operative time, less blood loss, and shorter length of stay, while preserving oncologic outcomes in selected masses. Here, we aim to assess the feasibility of the RP approach in excising anterior renal masses. Methods Patients ≥18 years of age who underwent robotic nephron-sparing surgery for anterior renal masses were retrospectively identified (2008-2022). Baseline demographics, tumor characteristics, and peri-operative data were collected and characterized based on TP vs RP approaches. Wilcoxon rank sum test and Pearson’s chi-squared test were used to compare continuous and categorical variables, respectively. Results 216 patients were included – 178 (82.4%) underwent TP approach and 38 (17.6%) underwent RP approach. Baseline demographics, preoperative tumor size, and renal nephrometry scores were similar. The RP approach was associated with shorter operative (150 vs 203 min, p<0.001) and warm ischemia time (12 vs 21 min, p<0.001), and less blood loss (20 vs 100 cc, p=0.002) (Table 1). The RP approach was associated with shorter length of stay (1 vs 2 days, p<0.001) and less total complications (5.3% vs 19.1%, p=0.038). Major complication (Clavien-Dindo Grade >3) rates were similar. There was no difference in positive surgical margin rates or pathologic characteristics. Conclusions Robotic RP approach for nephron-sparing surgery is feasible for eligible anterior tumors and is associated with favorable perioperative outcomes with preserved negative surgical margin rates.