Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results

Xiaotao Yin,Sinan Jiang,Yu Yang,Jiaxiang Guo,Yi Xiao,Yongliang Lu,Han Ma,Hualiang Yu,Zhiqiang Shao,Jiangping Gao,Xiaoying Zhu

doi:10.1186/s12957-020-01928-2

Abstract

PurposeThe retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses an additional surgical challenge due to the special location and poor tumor exposure. We developed a novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN and evaluated its efficacy in a retrospective case-control comparative study.MethodsFrom March 2016 to April 2019, a total of 39 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique, which improved the tumor exposure by opening the peritoneum and rotating the kidney ventrally, was applied in 24 cases, and the conventional RAPN was performed in the other 15 cases (control group). Perioperative data was analyzed to evaluate the efficacy of the kidney ventrally rotation technique.ResultsIn kidney rotation group, the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The warm ischemia time was 17.4 ± 6.6 min, which was significantly shorter than 24.5 ± 8.3 min in control group. The mean operation time (80 ± 24 min) and estimated blood loss (104 ± 65 ml) were not different from the control group. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases.ConclusionKidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient option for the management of posterior hilar tumor.

Highlights

Robot-assisted laparoscopic partial nephrectomy (RAPN) is demonstrated to be superior to conventional laparoscopic partial nephrectomy (LPN) in terms of estimated blood loss and warm ischemia time, because of the 3D vision and precise dissection of the robotic system [1, 2]
The posterior hilar tumor locates behind the hilar vessels, so the retroperitoneal approach may be more direct and suitable without interference of hilar vessels
24 cases that were applied kidney ventrally rotation technique were included in the kidney rotation group, and 15 cases that underwent conventional retroperitoneal RAPN were included in control group

Summary

Introduction

Robot-assisted laparoscopic partial nephrectomy (RAPN) is demonstrated to be superior to conventional laparoscopic partial nephrectomy (LPN) in terms of estimated blood loss and warm ischemia time, because of the 3D vision and precise dissection of the robotic system [1, 2]. The choice of operation approach during RAPN mainly depends on the tumor location, for example, transperitoneal approach for anterior tumor and retroperitoneal approach for posterior tumor [3]. The posterior hilar tumor locates behind the hilar vessels, so the retroperitoneal approach may be more direct and suitable without interference of hilar vessels. The exposure of posterior hilar tumor during retroperitoneal RAPN is still difficult in some cases because of the narrow retroperitoneal space, even for the experienced surgeon. We propose a novel efficient kidney ventrally rotation technique, which improves the exposure of the posterior hilar tumor by opening the ventral peritoneum and rotating the kidney ventrally. We would describe this technique and evaluate its feasibility and efficacy in a retrospective casecontrol comparative study including patients who underwent retroperitoneal RAPN for posterior hilar tumor

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