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Page 10 of 11 Bianchi et al. Mini-invasive Surg 2021;5:37 https://dx.doi.org/10.20517/2574-1225.2021.64

robotic ports in a caudally convex arc, 8 cm apart, lowers the risk of arm conflict. This robotic port
[22]
configuration was already described by Mittakanti et al. reporting the rRAPN technique using the da
Vinci Xi Surgical System. Conversely, placing the assistant port dorsally and not ventrally enables always
having two instruments ventral (the two 8 mm robotic ports) and two instruments dorsal (the other 8 mm
robotic port and the 12 mm AirSeal® assistant port) to the camera. This balances retroperitoneal space
management and provides, without triangulation, improved freedom of movement for the robotic arms,
with two instruments coming from each side, as opposed to other described techniques, where three
instruments are brought in anteriorly (two 8 mm robotic ports and the assistant port), reducing potential
clashing of the robotic arms. This is further aided by the da Vinci Xi laser targeting system and automatic
arm calibration. In addition, this port configuration gives the assistant more room to work externally and
provides an improved angle at which to provide assistance.

Furthermore, the advent of the most recent surgical robot, the single-port da Vinci SP, may facilitate an
[23]
even more flexible access, even in the field of retroperitoneal renal surgery .

Conclusions
We present in this manuscript a new retroperitoneal access technique for RAPN, developed to facilitate the
robotic approach for posterior masses, without any need of a balloon dissector and with better
retroperitoneal space management. However, data regarding this technique are still maturing, therefore
further studies will be presented in time.

DECLARATIONS
Authors’ contribution
Study concept and design: Antonelli A, Tafuri A, Bianchi A
Drafting of the manuscript: Bianchi A, Cianflone F
Critical revision of the manuscript for important intellectual content: Antonelli A, Cerruto MA,
Migliorini F
Supervision: Antonelli A

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
All images were obtained from the same patient who signed an informed consent.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.