Single Port Modified Partial Nephrectomy: Novel Simultaneous Access to Peritoneal and Retroperitoneal Partial Nephrectomy, Initial Clinical Experience.

Since its FDA approval in 2018, Intuitive Surgical DaVinci Single Port (SP) robotic platform has been a successfully used technology for multiple urological procedures. The purpose of this study is to share our early intraoperative and perioperative outcomes and potential benefits for performing a lower anterior retroperitoneal access (LARA) incision for single-port robot-assisted partial nephrectomy (SP-RAPN). The LARA incision enables performing a trans- or retroperitoneal approach through the same incision and eases the transition to a retroperitoneal approach. This study is a prospective review of 78 SP Partial Nephrectomy cases between 03/2021 and 01/2023 by an experienced robotic surgeon. A single 2-3 cm oblique incision parallel to the external oblique muscle, one-third of the distance between the iliac crest and umbilicus, was used to insert the multichannel port to perform the RAPN. We extracted intra- and perioperative data of these patients to share the outcomes of this approach. SP-RAPN was successfully completed in 78 patients (38 females and 40 males) without conversion to open or laparoscopic techniques. The mean age was 61.2 ± 12.1 years. The mean tumor size was 3.0 ± 1.2 cm, 43 were right-sided masses, and 35 were left-sided. The R.E.N.A.L Nephrometry score ranged from (4-11) with an average of 7.0 ± 1.9. Average operating room time was 90.5 ± 24.6 min, estimated blood loss was 88.3 ± 134 ml and length of stay of 1.07 ± 0.7 days. 40/78 cases required clamping of the renal artery with average warm ischemia time 19.4 ± 6.7 min in patients who underwent clamping. No complications in all of 78 patients. This study demonstrates the feasibility and reproducibility of SP-RAPN using a LARA incision. This incision provides a standardized approach for surgeons to transition to the retroperitoneal approach using the SP platform.