Safety and feasibility of prone retroperitoneal robotic-assisted partial nephrectomy (prRAPN): a novel posterior approach and perioperative results - a prospective study.

PURPOSE: Lateral positioning remains standard for retroperitoneal robotic-assisted partial nephrectomy (rRAPN). Emerging single-port systems have expanded supine positioning applications in rRAPN. This study evaluates the feasibility and safety of novel prone retroperitoneal RAPN (prRAPN).

METHODS

From August 2023 to December 2024, 108 patients with renal tumors in various anatomical locations prospectively underwent prRAPN. Demographic and perioperative parameters were analyzed.

RESULTS

This prospective cohort (n = 108) demonstrated median age 59 years, BMI 24.6 kg/m², R.E.N.A.L. score 7, and PADUA score 9. 10 patients had stage ≥ 3 chronic kidney disease, 75 had an age-adjusted charlson comorbidity index ≥ 2 and 23 had an American Society of Anesthesiologists score ≥ 3. All 86 patients with renal malignancies achieved negative surgical margins. Operative outcomes demonstrated median hilar access time 5.3 min, warm ischemia time 20.3 min, operation time 47.3 min, and estimated blood loss 50 mL. Postoperative 90-day ΔeGFR decreased by 7.2 mL/(min·1.73m2). Learning curve inflection points occurred at 52 cases for operation time. No conversions to open surgery or radical nephrectomy occurred, with one blood transfusion required. Nine minor and one major complications were recorded postoperatively. Limitations include small-sample size, short follow-up, and no controls.

CONCLUSIONS

Preliminary results demonstrated prRAPN is feasible and safe, which could expedite access to surgical area and improve exposure of posterior tumor. Larger-scale and multi-center studies are needed for confirmation.