Retroperitoneal single port vs. transperitoneal multiport robot assisted partial nephrectomy in patients with highly hostile abdomen: comparative analysis from a tertiary care center

BACKGROUND: The aim of this study was to explore perioperative and functional outcomes in a cohort of patients with highly hostile abdomens treated with retroperitoneal (RP) single port vs transperitoneal multiport robot assisted partial nephrectomy. METHODS: Clinical and surgical data of all consecutive patients treated with transperitoneal multiport and RP 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). RP 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 RP procedures. Adjusting for age, BMI and CCI, RP single port approach was confirmed as independent predictor of Trifecta achievement (OR 1.62 CI 1.18-2.35 P=0.01). CONCLUSIONS: In patients treated with RAPN with highly hostile abdomens, the adoption of a single port RP approach reduces the major complication rate as compared to the multiport transperitoneal approach also improving EBL, operative time, LOS and pain management.