Camera Port Swapping in Transperitoneal Robotic Partial Nephrectomy: A Feasible Alternative to the Retroperitoneal Approach for Posterior Renal Tumors

Abstract

Background: Robotic partial nephrectomy (RPN) for posterior renal tumors can be performed via the transperitoneal approach (TA); however, it may provide suboptimal visualization of posterior lesions compared to the retroperitoneal approach (RA). The camera port swapping (CPS) technique was developed to enhance intraoperative visualization and robotic arm maneuverability during TA-RPN. Methods: We conducted a retrospective review of patients who underwent RPN for posterior renal tumors between 2018 and 2024 using either TA with the CPS technique (n = 35) or RA (n = 29). All procedures used the da Vinci Xi surgical system, and the CPS technique involved repositioning the camera port intraoperatively when standard visualization proved inadequate during TA. Propensity score matching (1:1) was performed based on tumor size and body mass index to compare outcomes (n = 21 in each group). Results: Propensity score-matching analysis revealed that body mass index, tumor size, and RENAL nephrometry score were comparable between the two groups. The positive surgical margin was zero in all patients. The warm ischemia time was 22 min (0-44 min) in the TA-CPS group and 18 min (7-45 min) in the RA group (p = 0.504). No complications of Clavien-Dindo classification grade > 3 occurred in the TA-CPS group, while one occurred in the RA group (p = 1.000). Renal function decline was 4.8% in the TA-CPS group and 19% in the RA group (p = 0.343). Trifecta achievement rates were also comparable: 95.2% in the TA-CPS group and 81.0% in the RA group (p = 0.343). Conclusions: Camera port swapping during TA-RPN provided adequate visualization and perioperative outcomes comparable to those achieved with RA-RPN. This may be a practical alternative, particularly for anatomically complex posterior tumors.