Laparoscopic partial nephrectomy has increasingly become the preferred approach for treating clinical T1 renal tumors, providing advantages such as reduced blood loss and fewer complications compared to open surgery, while achieving similar oncologic outcomes. For posterior upper pole renal tumors, partial nephrectomy can be performed through either a transperitoneal or retroperitoneal approach. The retroperitoneoscopic approach in the prone position provides direct access to the renal hilum and posterior upper pole tumors without requiring the mobilization of intraperitoneal organs, which leads to shorter operative times and decreased blood loss. This study aims to share the initial experience with this technique in managing posterior upper-pole renal tumors.

Between August 2024 and March 2025, three patients with posterior upper-pole renal tumors were selected for retroperitoneoscopic partial nephrectomy in the prone position. After general anesthesia induction, the patients were positioned in the prone position with proper padding of pressure points. Three trocars were inserted to access the retroperitoneal space, which was insufflated with CO₂. The tumor was excised after careful dissection of the peritumoral fat, and the renal defect was sutured with continuous Vicryl sutures. The renal artery was clamped with a bulldog clamp during the tumor excision

All three cases underwent retroperitoneoscopic partial nephrectomy without any intraoperative or postoperative complications. The operative times ranged from 60 to 130 minutes, with estimated blood loss ranging from 20 to 100 mL. The warm ischemia times varied from 11 to 25 minutes. The mean operative time was 88.3 minutes. All patients had negative tumor margins and were discharged within four days post-surgery. There was no need to convert to another surgical approach

Retroperitoneoscopic partial nephrectomy in the prone position is a feasible and effective option for managing posterior upper-pole renal tumors. This approach offers several advantages, including reduced operative time, minimal blood loss, and faster recovery, without compromising oncologic outcomes. This report presents our initial experience with the technique, which can serve as a valuable alternative to traditional approaches in treating posterior upper-pole renal tumors.