Anatomical tour: Single-port retroperitoneal partial nephrectomy.

PURPOSE OF REVIEW: The single-port (SP) robotic platform has reshaped minimally invasive renal surgery, and the retroperitoneal low anterior access (LAA) approach has emerged as a versatile, increasingly favored technique. As adoption grows, surgeons need a detailed, anatomically grounded account of the operative steps and decision points unique to SP retroperitoneal partial nephrectomy, an account that current literature does not provide.

RECENT FINDINGS: The advent of the da Vinci SP platform has reduced the influence of tumor location on surgical approach selection. Whereas anterior, posterior, hilar, and polar tumors often dictated whether a transperitoneal or retroperitoneal approach was chosen in multiport robotic surgery, contemporary SP series have demonstrated the feasibility of treating a broad spectrum of renal tumor locations through a retroperitoneal approach. The ability to work effectively within confined spaces allow access to anterior, posterior, hilar, upper-pole, and lower-pole masses from a single access site and patient position. These developments have expanded the applicability of retroperitoneal surgery and has facilitated its adoption among trainees and surgeons with previous transperitoneal experience. As a result, traditional paradigms that relied heavily on tumor location for operative planning are being increasingly reconsidered.

SUMMARY: A retroperitoneal-first strategy with the SP platform simplifies access, shortens setup time, and broadens applicability across tumor locations, supporting its expanding role in nephron-sparing surgery. Comparative and long-term outcome data are still needed to refine patient selection.