The retroperitoneal robot-assisted partial nephrectomy (RRAPN) can have outcome like laparoscopic and robotic transperitoneal partial nephrectomy. It can provide advantages like no peritoneal breach, thereby safeguards the bowel and the solid organs, can decrease ileus and can be useful in patients with previous abdominal surgeries. The direct access to hilum and omitting steps of transperitoneal partial nephrectomy like bowel mobilisation can shorten the operating time and the warm ischemia time (WIT). This approach is more feasible to the patients with posterior tumours and few lateral tumours. In this video, we demonstrated two cases of RRAPN where we explored the safety and feasibility of the retroperitoneal approach in robot-assisted partial nephrectomy. We also tried to know the various technical nuances and the perioperative outcomes of retroperitoneal robot-assisted partial nephrectomy.

Our first patient, a 32 years/ Female had an incidentally detected right renal mass. The CT showed a well-defined solid enhancing predominantly endophytic soft tissue density lesion crossing the polar lines arising from the mid pole of right kidney 3.4x2.7x2.3 cm (R.E.N.A.L. score 8x). She underwent RRAPN. The console time and the WIT were 56 minutes and 18 minutes, respectively. The blood loss was approximately 50 ml. Our second patient, a 43 years/ Female presented with an incidentally detected right renal mass. The CT showed a well-defined heterogeneously enhancing exo-endophytic soft tissue lesion in the lower pole of left kidney 1.7x1.1x1.7 cm (R.E.N.A.L. score 5p). She underwent RRAPN. The console time and the WIT were 70 minutes and 28 minutes, respectively. The blood loss was approximately 40 ml. We have also produced the perioperative outcome data of all the 29 patients who underwent RRAPN in our institute (Figure 1)

Both patients had uneventful postoperative recovery. Both of them were discharged on postoperative day-2. On follow-up they are doing well without any evidence of disease.

The retroperitoneal approach of robot-assisted partial nephrectomy is safe and can be performed in complex scenario like predominantly endophytic tumours. Robotic approach provides excellent maneuverability in retroperitoneum. However, proper space creation has paramount importance. This approach can be performed without increasing the console time and warm ischemia time with no major complications.