The application of internal traction technique in retroperitoneal robot-assisted partial nephrectomy for renal ventral tumors

Background: For patients with prior intra-abdominal surgery or multiple arteries, the retroperitoneal robot-assisted partial nephrectomy (rRAPN) is a better choice. The renal ventral tumor poses an additional challenge due to poor tumor exposure. This study is determined to assess the feasibility of an internal traction technique (ITT) in rRAPN for the management of renal ventral tumors. Methods: From November 2019 to March 2021, a total of 28 patients with renal ventral tumor underwent rRAPN. All patients had prior abdominal surgery or multiple arteries. The ITT group (20 patients), which improved the tumor exposure by traction of the kidney with suture, was compared with the traditional technique group (8 patients) in terms of warm ischemia time, estimated blood loss and postoperative hospital stay, retroperitoneal drainage, R.E.N.A.L. score and serum creatinine. Differences were considered significant when P < 0.05. Results: All rRAPN surgeries were successful without conversion to radical nephrectomy or open partial nephrectomy. The warm ischemia time was lower in the ITT group (17.10 min vs. 24.63 min; p<0.05). Estimated blood loss in the traditional technique group was 324.88±79.42 mL, and in the ITT group was 117.45±35.25 mL (p<0.05). No significant differences with regards to postoperative hospital stay, retroperitoneal drainage, R.E.N.A.L. score and serum creatinine were observed between both groups. Surgical margins were negative and no intraoperative complications occurred in all the patients. After 10 months follow-up, no recurrence or metastasis occurred in all cases. Conclusion: ITT is a feasible, safe, and valid procedure in rRAPN for renal ventral tumors. Application of ITT improved the exposure and reduces warm ischemic time in comparison with conventional procedure.