Transperitoneal vs. retroperitoneal robotic partial nephrectomy: a matched-paired analysis

  • Harsha R. MittakantiEmail author
  • Gerald Heulitt
  • Hsin-Fang Li
  • James R. Porter
Topic Paper



When performing robotic nephron-sparing surgery (NSS) for renal tumors, either a transperitoneal approach or retroperitoneal approach can be utilized. The operative technique for robotic retroperitoneal partial nephrectomy (RPPN) is discussed and a matched-paired analysis comparing both RPPN and transperitoneal partial nephrectomy (TPPN) at a single institution is discussed.

Materials and methods

A retrospective review over a 10-year period (2006–2016) was performed for all patients who underwent robotic partial nephrectomy. A total of 281 patients underwent RPPN and 263 patients underwent TPPN. A matched-paired analysis was performed on 166 pairs of patients and the outcomes reviewed.


Operative time (p < 0.001) and estimated blood loss (p < 0.001) were significantly less in the RPPN group compared to the TPPN group. No differences (p > 0.05) were seen with regard to complexity of cases, warm ischemia time, tumor pathology, positive margin rates, complications, or kidney function post-operatively.


Robotic RPPN and TPPN can both be used for NSS with good results. RPPN, when used appropriately, can lead to shorter operative times, less blood loss and equivalent oncologic and post-operative outcomes. Surgeon comfort and expertise will help determine which approach to use.


Kidney neoplasms Nephrectomy Retroperitoneal space Minimally invasive surgical procedures Laparoscopy Robotics 


Author contributions

HRM data analysis and manuscript writing/editing. GH project development, data collection/management, and manuscript writing/editing. HFL data analysis. JRP project development, data collection/management, manuscript writing/editing.

Conflicts of interest

Dr. James Porter: Speaker for Intuitive Surgical, Consultant for Ceevra, C-SATS advisory board. The other authors declare that they have no competing interest.

Research involving human participants

This was a retrospective study on human participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol 198:520–529CrossRefGoogle Scholar
  2. 2.
    Sammon JD, Karakiewicz PI, Sun M, Ravi P (2013) Robot-assisted vs laparoscopic partial nephrectomy: utilization rates and perioperative outcomes. Int Braz J 39:377–386CrossRefGoogle Scholar
  3. 3.
    Wright JL, Porter JR (2005) Laparoscopic partial nephrectomy: comparison of transperitoneal and retroperitoneal approaches. JURO 174(3):841–845Google Scholar
  4. 4.
    Hu JC, Treat E, Filson CP, McLaren I, Xiong S, Stepanian S et al (2014) Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: a multicenter study. Eur Urol 66(3):542–549CrossRefGoogle Scholar
  5. 5.
    Xia L, Zhang X, Wang X, Xu T, Qin L, Zhang X et al (2016) Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis. Int J Surg 30(C):109–115CrossRefGoogle Scholar
  6. 6.
    Kim EH, Larson JA, Potretzke AM, Hulsey NK, Bhayani SB, Figenshau RS (2015) Retroperitoneal robot-assisted partial nephrectomy for posterior renal masses is associated with earlier hospital discharge: a single-institution retrospective comparison. J Endourol 29(10):1137–1142CrossRefGoogle Scholar
  7. 7.
    Choo SH, Lee SY, Sung HH, Jeon HG, Jeong BC, Jeon SS et al (2014) Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisons by nephrometry scores. World J Urol 32(6):1523–1529CrossRefGoogle Scholar
  8. 8.
    Hughes-Hallett A, Patki P, Patel N, Barber NJ, Sullivan M, Thilagarajah R (2013) Robot-assisted partial nephrectomy: a comparison of the transperitoneal and retroperitoneal approaches. J Endourol 27(7):869–874CrossRefGoogle Scholar
  9. 9.
    Maurice MJ, Kaouk JH, Ramirez D, Bhayani SB, Allaf ME, Rogers CG et al (2017) Robotic partial nephrectomy for posterior tumors through a retroperitoneal approach offers decreased length of stay compared with the transperitoneal approach: a propensity-matched analysis. J Endourol 31(2):158–162CrossRefGoogle Scholar
  10. 10.
    Tanaka K, Shigemura K, Furukawa J, Ishimura T, Muramaki M, Miyake H et al (2013) Comparison of the transperitoneal and retroperitoneal approach in robot-assisted partial nephrectomy in an initial case series in Japan. J Endourol 27(11):1384–1388CrossRefGoogle Scholar
  11. 11.
    Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Russo P (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740. CrossRefGoogle Scholar
  12. 12.
    Kim SP, Murad MH, Thompson RH, Boorjian SA, Weight CJ, Han LC, Leibovich BC (2012) comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. Google Scholar
  13. 13.
    Fan X, Xu K, Lin T, Liu H, Yin Z, Dong W, Huang J (2013) Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. BJU Int 111(4):611–621. CrossRefGoogle Scholar
  14. 14.
    Xia L, Talwar R, Taylor BL, Shin MH, Berger IB, Sperling CD, Guzzo TJ (2019) National trends and disparities of minimally invasive surgery for localized renal cancer, 2010 to 2015. Urol Oncol. Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Harsha R. Mittakanti
    • 1
    Email author
  • Gerald Heulitt
    • 1
  • Hsin-Fang Li
    • 2
  • James R. Porter
    • 1
  1. 1.Swedish Urology GroupSeattleUSA
  2. 2.Providence Health ServicesPortlandUSA

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