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Background and objectiveBenign retroperitoneal tumors (BRTs) are clinically rare solid tumors. This study aimed to compare the safety and efficacy of laparoscopic transperitoneal versus retroperitoneal resection for BRTs.MethodsThe clinical data of 43 patients who had pathologically confirmed BRTs and underwent laparoscopic resection in a single center from January 2019 to May 2022 were retrospectively analyzed. Patients were divided into two groups according to the surgical methods: the Transperitoneal approach group (n = 24) and the Retroperitoneal approach group (n = 19). The clinical characteristics and perioperative data between the two groups were compared. The baseline data and surgical variables were analyzed to determine the impact of different surgical approaches on the treatment outcomes of BRTs.ResultsNo significant difference was observed between the two groups in gender, age, body mass index, the American Society of Anesthesiologists score, presence of underlying diseases, tumor size, tumor position, operation duration, intraoperative hemorrhage, postoperative hospital stay, intestinal function recovery time, and postoperative complication rate. The conversion rate from laparoscopic to open surgery was significantly lower in the Transperitoneal approach group than in the Retroperitoneal approach group (1/24 vs. 5/19, χ2 = 4.333, P = 0.037). Tumor size was an independent influencing factor for the effect of surgery (odds ratio = 1.869, 95% confidence interval = 1.135–3.078, P = 0.014) and had a larger efficacy on the retroperitoneal group (odds ratio = 3.740, 95% confidence interval = 1.044–13.394, P = 0.043).ConclusionThe laparoscopic transperitoneal approach has the inherent advantages of anatomical hierarchies and surgical space, providing a better optical perspective of the targeted mass and improved bleeding control. This approach may have better efficacy than the retroperitoneal approach, especially in cases of a large tumor or when the tumor is located near important blood vessels.

PurposeAdoption of robotic retroperitoneal surgery has lagged behind robotic surgery adoption in general due to unique challenges of access and anatomy. We evaluated our initial results with robotic retroperitoneal robotic partial nephrectomy (RRPN) after transitioning from exclusively transperitoneal robotic partial nephrectomy (TRPN) to evaluate safety and any identifiable learning curve.MethodsWe evaluated our single-surgeon (RA) prospective partial nephrectomy database since adopting RRPN routinely for posterior tumors in 2017. The surgeon had previously performed 410 partial nephrectomies by this time. Outcomes were compared after the initial 30 RRPN.ResultsOf 137 patients since adopting RRPN, two attempted RRPN were converted to TRPN without complications due to morbid obesity affecting access, and 30 RRPN were completed (107 TRPN). There were no statistically significant differences in demographics, mean tumor size, or RENAL score between groups. Mean blood loss was lower in RRPN (53 mL vs 99 mL, P < 0.05), but there were no transfusions in either group. There was no difference in mean operative (127.8 min vs 141.2 min, P = 0.06) or ischemia time (11.1 min vs 10.8 min, P = 0.98). There were no positive margins in either group. Mean length of stay was lower in RRPN due to more same-day discharges (0.7 vs 0.9 days). There were no 90-day Clavien III–V complications. One RRPN patient was readmitted POD#8 overnight for hypoxia, and one visited the emergency room POD#7 for persistent pain. All three TRPN complications were managed as outpatients.ConclusionsSuccessful adoption of RRPN can be achieved readily after experience with TRPN. Outcomes were immediately comparable without any identifiable learning curve.

Background We report two rare cases of retroperitoneal schwannoma completely resected by a laparoscopic medial-retroperitoneal approach aided by virtual navigation. Three-dimensional images have been used in liver and lung surgery, but there are few prior reports on retroperitoneal surgery. Case presentation These two case reports are of a 60-year-old man and a 40-year-old man with asymptomatic retroperitoneal schwannoma. In both cases, the tumors were located in the right renal hilum and were close to the duodenum, right ureter, and inferior vena cava. Simulation using three-dimensional images was performed before surgery, and a medial-retroperitoneal approach was performed to secure a wide surgical field. During the operation, we confirmed the location of the main feeder and the relationship between the tumor and organs with those shown on the three-dimensional images and performed total laparoscopic resection. Conclusion The medial-retroperitoneal approach provides operative safety. Preoperative simulation and intraoperative navigation with three-dimensional images, which can be freely rotated and interactively visualized from any angle, are useful methods to enhance the surgeon’s understanding of a patient’s specific anatomy and are especially effective when resecting a retroperitoneal tumor that is located in an anatomically deep and complex location.

BackgroundAlthough numerous studies have been published on robotic adrenalectomy (RA) in the literature, none has done a comparison of posterior retroperitoneal (PR) and transabdominal lateral (TL) approaches. The aim of this study was to compare the outcomes of robotic PR and TL adrenalectomy.MethodsThis is a retrospective analysis of a prospectively maintained database. Between September 2008 and January 2017, perioperative outcomes of patients undergoing RA through PR and TL approaches were recorded into an IRB-approved database. Clinical and perioperative parameters were compared using Student’s t test, Wilcoxon rank-sum test, and χ2 test. Multivariate regression analysis was performed to determine factors associated with total operative time.Results188 patients underwent 200 RAs. 110 patients were operated through TL and 78 patients through PR approach. Overall, conversion rate to open was 2.5% and 90-day morbidity 4.8%. The perioperative outcomes of TL and PR approaches were similar regarding estimated blood loss, rate of conversion to open, length of hospital stay, and 90-day morbidity. PR approach resulted in a shorter mean ± SD total operative time (136.3 ± 38.7 vs. 154.6 ± 48.4 min; p = 0.005) and lower visual analog scale pain score on postoperative day #1 (4.3 ± 2.5 vs. 5.4 ± 2.4; p = 0.001). After excluding tumors larger than 6 cm operated through TL approach, the difference in operative times persisted (136.3 ± 38.7 vs. 153.7 ± 45.7 min; p = 0.009). On multivariate regression analysis, increasing BMI and TL approaches were associated with longer total operative time.ConclusionThis study shows that robotic PR and TL approaches are equally safe and efficacious. With experience, shorter operative time and less postoperative pain can be achieved with PR technique. This supports the preferential utilization of PR approach in high-volume centers with enough experience.

ABSTRACT Introduction Cerebral air embolism accompanied by right‐to‐left shunt through the venous system during Robot‐assisted partial nephrectomy (RAPN) is regarded as a rare occurrence, with a high mortality rate. Case Presentation A case of a 77‐year‐old man with renal cell carcinoma who developed cerebral air embolism during right retroperitoneal RAPN using AirSeal. Intraoperatively, a sudden drop in end‐tidal CO2 was observed during tumor resection. Postoperatively, the patient developed seizures, and imaging revealed cerebral air embolization. Despite hyperbaric oxygen therapy and intensive care, he progressed to fatal cerebral infarction. Conclusion This case highlights the risk of serious brain stroke during RAPN. The pathways of air entry into the cerebral circulation occasionally remain unclear and are difficult to fully exclude preoperatively. Renal vein clamping and adequate insufflation pressure are recommended when the tumor is entirely endophytic or close to the renal vein, especially when performing a right retroperitoneal approach.

Background In patients with high BMI and cardiopulmonary disease, the specificity of the laparoscopic approach may be an obstacle to the use of minimally invasive surgery. The primary retroperitoneal approach may overcome some of the unfavorable aspects of laparoscopic surgery and provide new possibilities for minimally invasive treatments. In this report, we present right colon resection using a primary retroperitoneal approach, in a patient with adhesions caused by previous surgical interventions. Methods A single-port single-access system is placed in the right lateral region of the abdomen. Dissection was performed between Toldt's fascia and Gerota's fascia. Medial to the head of the pancreas, the posterior layer of the mesentery was dissected along the course of the superior mesenteric artery and the dissection continues caudally. The roots of the ileocolic vessels were identified, clipped and cut at their origin while the dissection of the D3 lymph node was carried out along the trunk of Gillot up to the origin of the middle colic artery. Results The right colonic resection with D3 lymph node dissection was performed with primary retroperitoneal approach. The duration of the surgery was 240 min, with blood loss up to 100 ml. The incidence of pain syndrome in the early postoperative period was low and the hospital stay lasted 7 days. Conclusion The primary retroperitoneal approach appears to be safe for the treatment of cecal colon cancer. The anatomical structures are accessible and easy to visualize, allowing for safe resection of the right colon with extended D3 lymph node dissection.

Objective With the rising frequency and earlier onset of endometrial cancer (EC), improved surgical skills have emerged as a priority. The objective of this study was to determine the effectiveness and safety of transumbilical laparoendoscopic single-site surgery (TU-LESS) via the retroperitoneal approach for lymphadenectomy and multi-port laparoscopic surgery (MLS) in high-risk EC patients. Methods This retrospective study included 48 high-risk EC patients from June 2022 to June 2023. Twenty-two patients underwent TU-LESS (experimental group) via a retroperitoneal approach and 26 patients underwent MLS via the transperitoneal approach for lymphadenectomy (control group) with all patients undergoing lymph node dissection. Groups were matched for perioperative outcomes, lymph node harvest, tumor markers, pain scores, cosmetic satisfaction, complication rates, and quality of life 24 months postoperatively. Results Operative duration, blood loss, number of pelvic lymph nodes harvested, and complication rate were similar between groups ( P  > 0.05). The experimental group had more para-aortic lymph nodes removed (12.7 ± 4.1 vs. 8.3 ± 3.7), fewer catheterization days (2.1 vs. 3.4 d), fewer days to drainage removal (3.5 vs. 5.0 d), a shorter length of hospital stay (6.2 vs. 8.0 d), a lower postoperative visual analogue scale score (3.2 vs. 4.5), and lower tumor marker levels than the control group (all P  < 0.01). Neither group reported intra- or post-operative complications. Cosmetic satisfaction was better in the experimental group than the control group. The 24-month follow-up evaluation demonstrated improved quality of life without recurrence in both groups. Conclusion TU-LESS is a safe and effective method for high-risk EC with better recovery and cosmetic results, a good quality of life, and no recurrences or complications during 24 months of follow-up care. Due to the small sample size, short period of follow-up, and the confounding factors of study design, the results warrant further validation with additional cases from multiple centers long-term follow-up.

Background Partial nephrectomy (PN) has been the main strategy for treating cT1 (≤ 7 cm) renal tumors. Previous studies have established PN’s safety and effectiveness over radical nephrectomy (RN) for cT1 tumors. However, the efficacy and safety of retroperitoneal PN for larger renal tumors (> 7 cm) remained controversial. Through a size-based comparative analysis of cT1 and cT2 tumors undergoing retroperitoneal PN, we explored the impact of renal tumors larger than 7 cm on perioperative, oncological, and functional outcomes. Materials and methods From January 2017 to April 2021, we collected data from 201 patients undergoing retroperitoneal laparoscopic or robot-assisted PN. Of these, 173 (86.1%) had tumors ≤ 7 cm (Group A) and 28 (13.9%) had tumors > 7 cm (Group B). We analyzed demographics (gender, age, Body Mass Index, Charlson Comorbidity Index, preoperative hemoglobin and renal function, tumor location, operative method, RENAL score, and complexity), perioperative (operative time, warm ischemic time, estimated blood loss, hospital stay, surgical margins, complications), and functional outcomes (changes in renal function pre- and postoperatively), along with recurrence rates. Results Mean tumor sizes in Group A and Group B were 3.67 ± 1.56 cm and 9.90 ± 2.97 cm, respectively. RENAL score analysis revealed a significant difference (7.64 vs. 9.21, P  < 0.0001), attributed to the Radius and Exophytic/Endophytic property parameters. Furthermore, Group B exhibited significantly higher tumor complexity( P  = 0.0009). In perioperative outcomes, Group B had a prolonged warm ischemic time (18.90 vs. 22.60 min, P  = 0.0486). However, there was no significant difference in estimated blood loss and complication rates. Regarding functional outcomes, only the reduction of estimated glomerular filtration rate on postoperative day 1 was significant (-0.74 vs. -8.31, p  = 0.016), with no significant differences at 3 months, 6 months, or 1 year postoperatively. For eGFR changes over time in Group B, declines at postoperative month 3 and postoperative year 1 were noted. Conclusion Despite higher preoperative RENAL scores and prolonged perioperative warm ischemic time, retroperitoneal PN for tumors > 7 cm demonstrated acceptable functional, oncological, and perioperative outcomes, with no observed gastrointestinal complications. Our findings support its feasibility as a treatment option for patients with > 7 cm or intermediate/high complexity renal tumors.

In this study, we investigated the outcomes of laparoscopic approaches for adrenal tumor resection in 67 patients from a single center with a median age of 51 (range 40–79). Predominantly comprising women, the majority of patients were overweight or obese. Adrenal tumors larger than 6 cm were mostly treated using the laparoscopic transperitoneal method (p < 0.001). Our results revealed that patients subjected to the retroperitoneal approach exhibited quicker recovery, as evidenced by faster resumption of oral intake and ambulation, along with reduced intraoperative blood loss and shorter hospitalization (p-value < 0.05). In contrast, patients subjected to the transperitoneal approach experienced minimal complications, though not statistically significant, despite the technique’s intricacy and slower recovery. These findings emphasize the significance of tailoring the surgical approach to individual patient characteristics, with particular emphasis on the tumor size. The choice between the retroperitoneal and transperitoneal methods should be informed by patient-specific attributes to optimize surgical outcomes. This study underscores the need for a comprehensive evaluation of factors such as tumor characteristics and postoperative recovery when determining the most suitable laparoscopic approach for adrenal tumor resection. Ultimately, the pursuit of individualized treatment strategies will contribute to improved patient outcomes in adrenal tumor surgery.

Introduction Laparoscopic heminephrectomy for renal cell carcinoma in horseshoe kidneys has been previously reported, but reports on the retroperitoneal approach remain limited. This paper presents a case demonstrating the feasibility and effectiveness of this surgical technique. Case Presentation A 74‐year‐old woman was diagnosed with two renal cell carcinomas in the right side of a horseshoe kidney in contrast‐enhanced computed tomography. A laparoscopic right heminephrectomy was performed using a retroperitoneal approach. This approach allowed for effective management of the complex vasculature supplying the isthmus. Additionally, the inferior mesenteric artery served as a reliable anatomical landmark, facilitating the identification of the optimal site for isthmus transection. Conclusion Retroperitoneoscopic heminephrectomy is a safe and effective surgical option for renal cell carcinoma in patients with horseshoe kidneys and represents an anatomically rational approach.