Retroperitoneal Single Port vs Transperitoneal Multiport Robot Assisted Partial Nephrectomy (RAPN) in Patients with Highly Hostile Abdomens, a tertiary referral center comparative analysis

Abstract

Purpose To explore perioperative and functional outcomes in a cohort of patients with highly hostile abdomens treated with retroperitoneal single port vs transperitoneal multiport robot assisted partial nephrectomy. Materials and Methods Clinical and surgical data of all consecutive patients treated with Transperitoneal Multiport and Retroperitoneal Single-Port Robot Assisted Partial Nephrectomy between March 2019 and January 2024 were prospectively collected and retrospectively analyzed. The presence of “hostile abdomen” was defined as personal history of at least one major abdominal surgery. Multivariable logistic regression analysis was used to assess independent predictors of Trifecta achievement. Results Overall, clinical and surgical data of 247 consecutive patients were prospectively collected, of these 71 met the inclusions criteria and were retrospectively analyzed. No differences emerged in baseline features. Previous surgery proximity to the site of partial nephrectomy was found comparable among groups (p = 0.21). Retroperitoneal single port group showed a significantly lower operative time (171 vs 235 min, p = 0.02) and estimated blood loss (70 vs 100 cc, p = 0.04) while open conversion was significantly higher (9.3%) in case of multiport treatment (p = 0.001). A significative lower rate of major postoperative complications (7.1 vs 16.3%, p = 0.03) as well as 90-days readmissions (p = 0.04) was found in case of single port retroperitoneal procedures. Adjusting for age, BMI and CCI, retroperitoneal single port approach was confirmed as independent predictor of Trifecta achievement (OR 1.62 CI 1.18–2.35 p = 0.01). Conclusion Single port retroperitoneal approach confirmed valuable perioperative outcomes reducing the major complication rate and minimizing the overall surgical impact on patients as compared to the multiport transperitoneal group.