The Transabdominal Lumbar Approach (TALA) for Robotic Renal Surgery-A Retrospective Single-Center Comparative Study and Step-by-Step Description of a Novel Approach

Simple Summary Robotic kidney cancer surgery is commonly performed by two different approaches: the transperitoneal approach (TP) and the retroperitoneal approach (RP). Both methods have challenges, such as limited space (RP) or difficulties in dissecting the renal artery (TP). A combination of both methods, called a hybrid approach, has been described before but not fully evaluated. The study proposed a new modified hybrid approach called the transabdominal lumbar approach (TALA). The study compared 20 consecutive patients undergoing RP and 20 patients using TALA. The study looked at factors such as operation time, blood loss, and complications. The study found that both methods were similar in most areas. In conclusion, TALA is a safe and promising approach that combines the benefits of RP and TP for kidney cancer surgery.Abstract The transperitoneal approach (TP) and the retroperitoneal approach (RP) are two common methods for performing nephrectomy or partial nephrectomy. However, both approaches face difficulties, such as trocar placement and limited working space (RP). TP is impaired in the case of dorsal tumors and dissection of the renal artery can be challenging due to the anatomic localization dorsally to the renal vein. A hybrid approach that combines both methods has been previously reported in a case series, but not evaluated systematically. This study proposes a modified hybrid approach, which we call the transabdominal lumbar approach (TALA), involving late robotic docking after elaborating the retroperitoneum using conventional laparoscopy. The study compares the last 20 consecutive patients who underwent RP and the last 20 patients who underwent TALA at our institution. The investigated variables include operative time and amount of blood loss, hospitalization duration, postoperative analgesia requirement, and postoperative complications. The study found no significant difference in operative time, blood loss, ischemia time, or hospital stay between the two groups. The TALA group had fewer complications regarding Clavien-Dindo category 3, but one complication of category 4. In Conclusion, TALA is a safe and promising approach that combines the advantages of RP and TP.