Abstract
Introduction:
With the increasing popularity of robot-assisted laparoscopic surgery, nephron-sparing renal surgery is becoming the treatment of choice for small renal masses. Historically, laparoscopic access to the kidney has been approached transperitoneally. A retroperitoneal approach offers direct access to the kidney and may offer an improved approach to nephron-sparing surgery, especially posterior tumors. 1 The confined space of the retroperitoneum can be navigated effectively by articulating robotic instruments. Effective instrument placement is critical to success retroperitoneal surgery. Several manuscripts describe the procedure, but obtaining access is largely ignored. 2,3 In this video, we demonstrate the technique of retroperitoneal robot-assisted laparoscopic port placement.
Materials and Methods:
We demonstrate the technique of robot-assisted laparoscopic port placement on patients with right- and left-sided renal masses, respectively. Obtaining retroperitoneal access off the tip of the 12th rib, we create an initial working space with a preperitoneal distension balloon. Blunt sweeping of the peritoneum is subsequently used to expand the working space. Four additional ports are placed under direct vision to accommodate a four-arm approach using the Da Vinci surgical system and one assistant port.
Results and Conclusions:
Robot-assisted laparoscopic retroperitoneal partial nephrectomy is an effective approach to nephron-sparing surgery. Surgical port placement using the described technique allows reliable access into the retroperitoneum.
No competing financial interests exist.
Runtime of video: 7 mins 31 secs
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