PERSPECTIVE article
Front. Surg.
Sec. Surgical Oncology
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1630319
This article is part of the Research TopicAdvancements and Challenges in Retroperitoneal Approaches for Urological SurgeriesView all 4 articles
Multiport Anterior Retroperitoneal Access (M.A.R.A.) for robotic-assisted partial nephrectomy: an innovative technique for renal tumour
Provisionally accepted
Tommaso Silvestri1*
Sara Riolo2Guglielmo Zeccolini1Bernardino De Concilio1Giovanni Costa1Roberto Knez1Damiano D'Aietti1Antonio Celia1- 1Ospedale San Bassiano, Bassano del Grappa, Italy
- 2Sapienza University of Rome, Rome, Italy
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Robotic Partial Nephrectomy can be performed via transperitoneal or retroperitoneal access. The retroperitoneal approach offers direct access to the renal artery and reduces the risk of intestinal injury, especially in patients with prior abdominal surgeries or adhesions. This study presents a novel retroperitoneal robotic technique using anterior trocar placement with the patient in lateral decubitus. Access is gained through a pararectal incision, with the AirSeal trocar placed first, followed by the creation of an extraperitoneal working space and placement of robotic trocars. After docking, the renal hilum is isolated, the mass is enucleated following arterial clamping, and the collecting system is sutured selectively. The procedure ends with hemostasis and drainage tube placement. This is the first reported use of anterior retroperitoneal access with the patient in lateral decubitus, differing from previous techniques performed in the supine position. Advantages include avoiding intraperitoneal adhesions and improved assistant access. The technique is especially suitable for renal tumors in the middle or lower third of the kidney but can also be applied to upper pole lesions. Preliminary outcomes are promising; further research with larger cohorts is needed to validate its effectiveness.
Keywords: Partial Nephrectomy, Robotic Partial Nephrectomy, Retroperiteonal, retroperitoneal partial nephrectomy, retroperitoneal access, retroperitoneal region, Kidney cancer, Localized kidney cancer
Received: 17 May 2025; Accepted: 25 Sep 2025.
Copyright: © 2025 Silvestri, Riolo, Zeccolini, De Concilio, Costa, Knez, D'Aietti and Celia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tommaso Silvestri, sara.riolo@uniroma1.it
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.