Robot-Assisted Laparoscopic Excision of Complicated Retroperitoneal Tumors with Four Arms Via Retroperitoneal Way: A Unique Minimal-Invasive Approach

Abstract

Background: Surgical management of complicated retroperitoneal mass is one of the most challenging urologic oncologic surgeries. This study aims to describe our technique and experience in dealing with retroperitoneal mass. Methods: Three patients with complicated retroperitoneal mass were treated with robot-assisted surgery with four arms through retroperitoneal approach. Surgical Procedure: Our standardized anatomic-based “kidney safe first, then mass resection” technique for robot-assisted complicated retroperitoneal mass resection focused on minimizing the chance of renal pedicle injury. Baseline demographics, pathology data, and latest follow-up outcome were obtained. Results: In this retrospectively reviewed case series, all 3 patients were successfully treated with robot-assisted surgery with four arms during retroperitoneal space. One patient received paravertebral mass resection 2 weeks after the robotic surgery. Mean data included operative time of 175 minutes, estimated blood loss was 133 mL, and hospital stay was 4 days. No complications occurred. Conclusions: Robot-assist surgery for complicated retroperitoneal mass with four arms is a safe and feasible way. Patient Summary: Mini-invasive treatment for retroperitoneal mass with robotic four arms through retroperitoneal approach is a feasible way. The approach reduces interruption of intracorporeal structure and organs. And patients could benefit from the retroperitoneal approach with a quicker recovery.