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Bianchi et al. Mini-invasive Surg 2021;5:37 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.64

Technical Note Open Access

Retroperitoneal approach for robot-assisted partial

nephrectomy: a step-by-step description of surgical
technique

1
1,2
1
1
1
Alberto Bianchi , Francesco Cianflone , Filippo Migliorini , Maria Angela Cerruto , Alessandro Tafuri ,
Alessandro Antonelli 1
1
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy.
2
Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University, Chieti 66100, Italy.
Correspondence to: Prof. Alessandro Antonelli, Department of Urology, University of Verona, Azienda Ospedaliera Universitaria
Integrata Verona, Piazzale Aristide Stefani 1, Verona 37126, Italy. E-mail: alessandro.antonelli@aovr.veneto.it; Dr. Alessandro
Tafuri, Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide
Stefani 1, Verona 37126, Italy. E-mail: alessandro.tafuri@univr.it
How to cite this article: Bianchi A, Cianflone F, Migliorini F, Cerruto MA, Tafuri A, Antonelli A. Retroperitoneal approach for
robot-assisted partial nephrectomy: a step-by-step description of surgical technique. Mini-invasive Surg 2021;5:37.
https://dx.doi.org/10.20517/2574-1225.2021.64
Received: 10 May 2021 First Decision: 9 Jun 2021 Revised: 16 Jun 2021 Accepted: 23 Jun 2021 First online: 2 Jul 2021

Academic Editors: Michele Marchioni, Luigi Schips Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
In the last decades, minimally invasive partial nephrectomy (PN) has gained traction and, as of today, robot-
assisted laparoscopic PN (RAPN) is increasingly being performed; this procedure might be performed with a
transperitoneal or retroperitoneal (rRAPN) approach. However, rRAPN is less standardized in the literature.
Therefore, we describe our rRAPN technique using a da Vinci Xi Surgical System and four robotic arms. First, with
the patient placed in full flank position, the camera port is placed at the level of the Petit’s triangle apex.
Retroperitoneal space is created by turning the index finger in a 180° movement through this port. After, the two
first 8 mm robotic ports are blindly placed with the surgeon’s index finger guide, 8 cm far from the first port,
respectively along the anterior and posterior axillary line; 3-5 cm caudally to the last one, a 12 mm AirSeal®
assistant port is placed in the same manner. To create space for the last 8 mm robotic port, the peritoneum is
reflected medially and downward off of the transversus abdominis muscle laparoscopically. Only then, the last port
is placed under direct vision 8 cm ventral and about 2 cm cephalad from the port on the anterior axillary line. The
robotic ports placement will result in a caudally convex arc. This technique, due to the extensive use of the surgeon
index, implies fast access to the retroperitoneum, protects the underlying anatomical structures from damage, and,
due to the trocar positioning along an arc, lowers the arm conflict risk.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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