Retroperitoneal Approach for Partial Robot-Assisted Nephrectomy

Nephron-sparing surgery is widely accepted as the preferred definitive treatment modality for small renal masses, and robotic-assisted surgery has evolved as an ideal approach given the benefits of improved instrument dexterity and visualization of key anatomic structures. While the transperitoneal approach has been preferred, posterior and lateral renal masses can be more directly accessed via a retroperitoneal approach reducing operative time, length of stay, and estimated blood loss without any increase in perioperative complications using this approach. In this chapter, we will discuss our approach for robotic-assisted retroperitoneal partial nephrectomy, with a focus on modifications for the obese patient.