title: Robotic retroperitoneal partial nephrectomy: a four-arm approach.
abstract: BACKGROUND
  Robotic partial nephrectomy is an effective alternative to laparoscopic partial nephrectomy. The 3-arm and 4-arm transperitoneal robotic approaches are well described in the literature. However, a retroperitoneal robotic technique has yet to be fully described. We report our technique and initial experience with robotic retroperitoneal partial nephrectomy with a novel 4-arm approach.
  
  
  METHODS
  We reviewed our current experience with the robotic retroperitoneal approach. Descriptive statistics on patient characteristics, operative parameters, and oncologic outcomes are reported.
  
  
  RESULTS
  A total of 67 robotic-assisted partial nephrectomies were performed by one surgeon between October 2009 and October 2010. The 4-arm retroperitoneal approach was used in 8 patients (12%) with no complications. Median tumor size was 2cm. All were posterior renal tumors, with 5 located in the upper pole. The median operative time, warm ischemia time, estimated blood loss, and length of stay were 202 minutes, 18 minutes, 100cc, and 2 days, respectively. Pathology indicated renal cell carcinoma (RCC) in 7 patients with negative margins.
  
  
  CONCLUSIONS
  The 4-arm robotic approach to retroperitoneal partial nephrectomy is safe, reproducible, and easily used. The fourth arm provides optimal traction on target tissues in key maneuvers and may decrease complications and positive margins secondary to impaired exposure.
authors.affiliation: NYU Langone Medical Center, Department of Urology, New York, NY 10016, USA. joseph.feliciano@gmail.com
authors.forename: Joseph
authors.initials: J
authors.lastname: Feliciano
authors.forename: Michael
authors.initials: M
authors.lastname: Stifelman
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome