Retroperitoneal Robotic Surgery – Part 1

This year marks the 20th anniversary of Georgia’s first laparoscopic kidney removal for cancer. When I performed this procedure back then, I was amazed how such a leap in medical technology would allow the removal of an entire kidney using several button-size incisions. Now, with the introduction of robotic surgery, we take these early advances for granted. However, some of these early lessons are worth remembering.

Laparoscopic surgeries are most commonly performed for structures in the abdominal cavity, gallbladder removal and hysterectomies being typical examples. Although the kidneys reside in the abdominal region, they actually exist in a much smaller space behind the abdominal cavity referred to as the “retroperitoneal space.”

While most urologists who perform laparoscopic kidney removal go through the abdominal cavity, I prefer a more direct route into the retroperitoneal space. Here are some key features to retroperitoneal surgery:

  • Fewer and less conspicuous incisions
  • Often quicker recovery
  • Often less pain
  • Less risk to abdominal structures such as intestines, pancreas, liver, and spleen
  • Cure rates equal to standard laparoscopy
  • Applicable to robotic surgery
  • Direct, immediate, and often safer access to the kidney’s large blood vessels

Although the learning curve for retroperitoneal surgery can be steep, the rewards for both the patient and surgeon are worth it. Next month, I will detail all of the steps of the procedure.