Transperitoneal Versus Retroperitoneal Single-port Robotic-assisted Partial Nephrectomy: An Analysis from the Single Port Advanced Research Consortium

Background: In the surgical management of kidney tumors, such as in multiport technology, single-port (SP) robotic-assisted partial nephrectomy (RAPN) can be performed using the transperitoneal (TP) or retroperitoneal (RP) approach. However, there is a dearth of literature on the efficacy and safety of either approach for SP RAPN.Objective: To compare the peri- and postoperative outcomes of the TP and RP approaches for SP RAPN.Design, setting, and participantsThis is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) database of five institutions. All patients underwent SP RAPN for a renal mass between 2019 and 2022.Intervention: TP versus RP SP RAPN.Outcome measurements and statistical analysis: Baseline characteristics, and peri- and postoperative outcomes were compared between both the approaches using chi(2) test, Fisher exact test, Mann-Whitney U test, and Student t test.Results and limitations: A total of 219 patients (121 [55.25%] TP, 98 [44.75%] RP) were included in the study. Of them, 115 (51.51%) were male, and the mean age was 60 +/- 11 yr. RP had a significantly higher proportion of posterior tumors (54 [55.10%] RP vs 28 [23.14%] TP, p < 0.001), while other baseline characteristics were comparable between both the approaches. There was no statistically significant difference in ischemia time (18 +/- 9 vs 18 +/- 11 min, p = 0.898), operative time (147 +/- 67 vs 146 +/- 70 min, p = 0.925), estimated blood loss (p = 0.167), length of stay (1.06 +/- 2.25 vs 1.33 +/- 1.05 d, p = 0.270), overall complications (5 [5.10%] vs 7 [5.79%]), and major complication rate (2 [2.04%] vs 2 [1.65%], p = 1.000). No difference was observed in positive surgical margin rate (p = 0.472) or delta eGFR at median 6-mo follow-up (p = 0.273). Limitations include retrospective design and no long-term follow-up.Conclusions: With proper patient selection based on patient and tumor characteristics, surgeons can opt for either the TP or the RP approach for SP RAPN, and maintain satisfactory outcomes.