• Meta-analysis
• Partial nephrectomy
• Retroperitoneal
• Robotic
• Transperitoneal

• Nephrectomy/methods
• Robotic Surgical Procedures/methods
• Humans
• Retroperitoneal Space/surgery
• Operative Time
• Propensity Score
• Length of Stay/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Peritoneum/surgery
• Blood Loss, Surgical/statistics & numerical data
• Treatment Outcome
• Glomerular Filtration Rate

• intraoperative ultrasound
• laparoscopic procedure
• partial nephrectomy
• renal cell carcinoma (rcc)
• robot-assisted partial nephrectomy
• uro-oncology

• enucleation
• renal cell carcinoma
• robot-assisted partial nephrectomy
• tumor recurrence
• tumor rupture
• warm ischemia time

• Humans
• Robotics/methods
• Retrospective Studies
• Neoplasm Recurrence, Local
• Treatment Outcome
• Kidney Neoplasms/surgery
• Kidney Neoplasms/pathology
• Nephrectomy/adverse effects
• Nephrectomy/methods

• Renal tumor
• Retroperitoneal approach
• Robot-assisted partial nephrectomy

The anterior approach is one of the widely used surgical treatments for lumbar spondylodiscitis, but it has the disadvantages of large trauma and a high incidence of complications. Our experiences suggested that the laparoscopic retroperitoneal approach could be effective to overcome those disadvantages of the anterior approach. Herein, we report two cases of successfully treated lumbar pyogenic spondylodiscitis using a robot-assisted laparoscopic retroperitoneal approach. The technique utilizes a robot that allows a laparoscopic retroperitoneal approach while offering excellent high-definition images of three-dimensional vision. After the operation, both patients achieved good formation and fusion of the vertebrae. Preliminary evidence suggests that the robot-assisted laparoscopic retroperitoneal approach may be feasible for the treatment of lumbar spondylodiscitis.

Retroperitoneal robotic partial nephrectomy is markedly restricted by limited space and visual field. We introduced a novel Gerota-edge-sling (GES) technique with self-designed traction devices to overcome these defects by attaching Gerota fascia to abdominal wall, and comparatively evaluated its utilization with routine technique.

A retrospective analysis was performed for consecutive patients who underwent routine (control group) or GES assisted (GES group) retroperitoneal robotic partial nephrectomy for localized renal tumors in our hospital between March 2018 and June 2020. Clinical data of perioperative outcomes and complications were collected and compared. Comparison of outcomes between anterior versus posterior tumor subgroups was also conducted. Linear regression analysis was used to define the relationship between dissection time and perinephric fat status in each group.

Totally 103 patients were included, 48 in control and 55 in GES group respectively. All the procedures were completed successfully without conversion or positive surgical margin. GES group had significantly decreased console time (91 ± 36 min vs. 117 ± 41 min, p < 0.01) and dissection time (67 ± 35 min vs. 93 ± 38 min, p < 0.01) than control, while ischemia time, blood loss, and nephrometry score comparable between them. No major postoperative complications occurred. Dissection time of GES group was notably shorter than that of control in both anterior/posterior subgroups. Only in control group, dissection time was positively associated with perinephric fat status.

The GES technique acting as an adjunct to robotic arms with space-sparing feature, notably improves surgical exposure and facilitates dissection in retroperitoneal partial nephrectomy, while having great feasibility, efficacy and safety.

The online version contains supplementary material available at 10.1186/s12894-022-01079-4.

• Kidney
• Oncology
• RENAL score
• Robotic surgery

• kidney cancer
• off-clamp
• on-clamp
• renal function
• robot-assisted partial nephrectomy

• Kidney cancer
• Kidney tumour
• Retroperitoneal robot-assisted partial nephrectomy
• Retroperitoneal robotic surgery
• Robotic partial nephrectomy

Partial nephrectomy (PN) is the gold standard treatment for appropriately selected renal masses. Recent surgical advancements and adoption of the robotic technique has led to greater adoption of nephron-sparing surgery. Robotic PN was initially described via the transperitoneal (TP) approach, however, retroperitoneal (RP) access is possible and in some cases more desirable. In the RP approach, the kidney is accessed from its posterior surface and the intraperitoneal space is avoided. The RP approach to PN has the benefit of avoiding intraperitoneal viscera and colonic mobilization in patients with extensive prior abdominal surgery. The technique also eliminates the need for renal unit rotation in patients with posterior tumors and affords access to masses directly posterior to the renal hilum. The RP and TP approach to PN have shown similar oncologic and perioperative outcomes. Several recent studies have reported shorter operative times and lengths of stay (LOS) with comparable warm ischemia times for the RP approach when compared to transperitoneal PN (tPN). Given the indispensable deliverables of this approach in select patients, robotic retroperitoneal PN (rPN) should be in the armamentarium of a versatile urologic kidney surgeon. This review describes the current state of rPN and compares the indications and outcomes of the TP and RP approaches.

• Retroperitoneoscopic
• partial nephrectomy (PN)
• renal mass
• robotic partial nephrectomy
• transperitoneal partial nephrectomy

• carcinoma, renal cell
• laparoscopy
• pregnancy trimester, second
• robotics

• Adult
• Carcinoma, Renal Cell/pathology
• Carcinoma, Renal Cell/surgery
• Child
• Female
• Humans
• Kidney Neoplasms/pathology
• Kidney Neoplasms/surgery
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Nephrectomy/methods
• Pregnancy
• Pregnancy Complications, Neoplastic/pathology
• Pregnancy Complications, Neoplastic/surgery
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Treatment Outcome

• Active surveillance
• Nomogram
• Partial nephrectomy
• Patient decision aid
• Radical nephrectomy
• Renal cell carcinoma
• Thermal ablation

• Humans
• Kidney Neoplasms/surgery
• Laparoscopy
• Nephrectomy
• Retrospective Studies
• Robotics
• Treatment Outcome

• Renal mass
• Retroperitoneal partial nephrectomy
• Robotic partial nephrectomy
• Robotic surgery
• Transperitoneal partial nephrectomy

• adrenal gland
• horse
• kidney
• retroperitoneal space
• retroperitoneoscopy

• off-clamp technique
• partial nephrectomy
• renal tumor
• retroperitoneal approach
• robotic surgery

• Blood Loss, Surgical/prevention & control
• Female
• Humans
• Kidney Neoplasms/surgery
• Laparoscopy/methods
• Male
• Middle Aged
• Nephrectomy/methods
• Retroperitoneal Space/surgery
• Retrospective Studies
• Robotic Surgical Procedures/methods
• Treatment Outcome

Renal ischaemia research has shown an increase in renal damage proportional to ischaemic time. Therefore, we assessed the importance of renal ischaemic times for warm and cold ischaemia approaches, and explored the different surgical techniques that can help to minimise renal ischaemia in robot-assisted partial nephrectomy (RAPN). Minimising renal ischaemia during nephron-sparing surgery (NSS) is a key factor in preserving postoperative renal function. Current data support a safe warm ischaemia time (WIT) of ≤25 min and cold ischaemic time of ≤35 min, resulting in no significant deterioration in renal function. In general, patients undergoing NSS have increased comorbidities, including chronic kidney disease, and in these patients it is difficult to predict their postoperative renal function recovery. With RAPN, efforts should be made to keep the WIT to <25 min, as minimising the ischaemic time is vital for preservation of overall renal function and remains a modifiable risk factor. Parenchymal or segmental artery clamping, early unclamping or off-clamp techniques can be adopted when ischaemic times are likely to be >25 min, but may not lead to superior functional outcome. Careful preoperative planning, tumour factors, and meticulous surgical technique are critical for optimum patient outcome.

• AKI, acute kidney injury
• AO, artery only
• CKD, chronic kidney disease
• Ischaemia
• NSS, nephron-sparing surgery
• Partial nephrectomy
• Renal cell carcinoma
• Renal function
• Renorrhaphy

• comparative outcomes
• kidney neoplasms
• retroperitoneal approach
• robotic partial nephrectomy
• robotic surgery

• Carcinoma, Renal cell
• Kidney
• Nephrectomy
• Radiofrequency catheter ablation
• Treatment outcome

• laparoscopic approach
• renal cancer
• robotics

• Baseline risk
• Bleeding
• Modeling
• Reporting
• Risk of bias
• Thromboprophylaxis
• Urology
• Venous thromboembolism

• Humans
• Postoperative Complications/epidemiology
• Postoperative Hemorrhage/epidemiology
• Risk Assessment
• Urologic Neoplasms/surgery
• Urologic Surgical Procedures
• Venous Thromboembolism/epidemiology

• Medical Research Council

• Partial nephrectomy
• Radical nephrectomy
• Renal cell carcinoma
• Renal masses
• Surgery

• Clinical Decision-Making
• Humans
• Kidney Neoplasms/diagnostic imaging
• Kidney Neoplasms/mortality
• Kidney Neoplasms/pathology
• Kidney Neoplasms/surgery
• Nephrectomy/adverse effects
• Nephrectomy/methods
• Nephrectomy/mortality
• Patient Selection
• Risk Assessment
• Risk Factors
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Tumor Burden

The choice of approach for partial nephrectomy often depends on surgical complexity. We aimed to determine if surgeon intuition was equivalent to markers of operative complexity, such as RENAL nephrometry and Mayo adhesive probability (MAP) score, in determining the surgical approach for partial nephrectomy (PN).

We retrospectively identified 119 masses removed for suspected renal cell carcinoma from January 2012 to September 2014 by a single surgeon who intuitively chose treatment with one of three surgical approaches: Open PN (OPN), robotic-assisted transperitoneal PN (RATPN), or robotic-assisted retroperitoneal PN (RARPN). Clinicodemographic characteristics, pathological features, and postoperative outcomes were compared for each approach. Logistic regression was performed to identify independent predictors of open surgical resection, our primary endpoint.

Fifty-four tumors (45%) were resected via OPN, 40 (34%) via RATPN, and 25 (21%) via RARPN. OPN was performed in patients with more comorbidities (P = 0.02), lower baseline renal function (P < 0.01), more solitary kidneys (P < 0.01), and more multifocal disease (P < 0.01). Patients undergoing OPN had higher median nephrometry scores compared to RATPN and RARPN patients (8 vs. 7 vs. 7, respectively; P = 0.03), but MAP scores were no different among all three groups (P = 0.36). On multivariate analysis, higher nephrometry scores (odds ratio: 1.41, 95% confidence interval: 1.10-1.81; P = 0.007) were independently associated with open surgical resection. Nephrometry score was predictive of OPN (area under curve = 0.64, P = 0.01) with a score of 6.5 having the highest sensitivity and specificity (76% and 42%, respectively).

RENAL nephrometry score was associated with surgical approach intuitively chosen by an experienced surgeon, but the presence of adherent perinephric fat did not correlate with decision-making.

• Intuition
• Mayo adhesive probability score
• nephrometry score
• partial nephrectomy
• robotic surgery
• surgical approach

AIM: To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach.

METHODS: Retrospective review was performed for patients who underwent robotic-assisted laparoscopic partial nephrectomy (RALPN) for a posterior renal tumor between 2009-2015. Patient demographic characteristics, operative factors, pathology, oncologic outcomes, renal function, and tumor complexity were obtained. Radius of the tumor, exophytic/endophytic properties of the tumor, nearness of tumor to the collecting system, anterior/posterior position, location relative to the polar line (RENAL) nephrometry scores were calculated. nephrometry scores were calculated. The operative approach was determined by the primary surgeon.

RESULTS: A total of 91 patients were identified who underwent RALPN for a posterior renal tumor. Fifty-four procedures were performed via the retroperitoneal (RP) approach, and 37 via the transperitoneal (TP) approach. There were no significant differences in patient factors (race, sex, age and body mass index), RENAL nephrometry scores, tumor size, conversion rates, or margin status. Among procedures performed on-clamp, there was no significant difference in warm ischemia times. Total operative time (180.7 min for RP vs 227.8 min for TP, P < 0.001), robotic console time (126.9 min for RP vs 164.3 min for TP, P < 0.001), and median estimated blood loss (32.5 mL for RP vs 150 mL for TP, P < 0.001) were significantly lower via the RP approach. Off-clamp RALPN was performed for 31 (57.4%) of RP procedures vs 9 (24.3%) of TP procedures. Oncologic and renal functional outcomes were equivalent.

CONCLUSION: The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to be performed off-clamp.

• Retroperitoneal
• Transperitoneal
• Robotic-assisted laparoscopic partial nephrectomy
• Posterior renal masses

• Cystectomy
• Nephrectomy
• Prostatectomy
• Robotics

• ablative therapy
• active surveillance
• laparoscopic surgery
• nephron sparing surgery
• renal cell carcinoma
• robotic-assisted laparoscopic surgery

• Functional outcomes
• MAG3
• Minimally invasive
• Partial nephrectomy
• Robotic
• Trifecta of outcomes

A major role in the establishment of computer-assisted robotic surgery (CARS) can be traced to the work of Mani Menon at Vattikuti Urology Institute (VUI), and of many surgeons of Asian origin. The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines, improving patient comfort and disease outcomes and helping the industrial growth. The present paper gives an overview of the progress and development of robotic surgery, especially in the field of Urology; and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world.

PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014, using algorithms based on keywords “robotic surgery”, ”prostate”, “kidney”, “adrenal”, “bladder”, “reconstruction”, and “kidney transplant”. Inclusion criteria used were published full articles, book chapters, clinical trials, prospective and retrospective series, and systematic reviews/meta-analyses written in English language. Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion, and focused on techniques of robotic surgery, relevant patient outcomes and associated demographic trends.

A total of 58 articles selected for final review highlight the important strides made by robots in urology, from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014. In the hands of an experienced robotic surgeon, it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery, especially in urologic oncology and reconstructive urology. With increasing surgeon proficiency, the benefits of robotic surgery were consistently seen across different surgical disciplines, patient populations, and strata.

The addition of robot to the surgical armamentarium has allowed better patient care and improved disease outcomes. VUI and surgeons of Asian origin have played a pioneering role in dissemination of computer-assisted surgery.

• Asian
• IDEAL
• Kidney transplant
• Nephrectomy
• Radical cystectomy
• Radical prostatectomy
• Reconstructive urology
• Robotic surgery