ORIGINAL RESEARCH article
Front. Surg.
Sec. Genitourinary Surgery and Interventions
This article is part of the Research TopicAdvancements and Challenges in Retroperitoneal Approaches for Urological SurgeriesView all 6 articles
Initial Experience with Single-Port Robot-Assisted Partial Nephrectomy Using the Low Anterior Access (LAA): Perioperative Outcomes and Learning Curve Analysis in a Belgian SP-naive Tertiary Robotic Referral Center
Provisionally accepted
Henri Van Eecke1,2*
Julien Grammens1,3
Peter De Kuyper1,3Wesley Verla1,3Filip Ameye1,2Simone Crivellaro4Karel Decaestecker1,3- 1AZ Maria Middelares vzw, Ghent, Belgium
- 2Katholieke Universiteit Leuven, Leuven, Belgium
- 3Universiteit Gent, Ghent, Belgium
- 4University of Illinois Chicago, Chicago, United States
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Objectives: Robot-assisted partial nephrectomy (RAPN) has become a standard minimally invasive approach for localized renal tumors. The introduction of the single-port (SP) robotic system has enabled novel retroperitoneal techniques, such as the Low Anterior Access (LAA). This study presents the initial experience of SP RAPN using the LAA technique in a SP-naive Belgian tertiary robotic referral center. Methods: A retrospective database was created with prospectively collected data from patients who underwent SP RAPN via LAA between May 2024 and September 2025. All procedures were performed by a SP robot-naive surgeon with extensive multi-port transperitoneal robotic experience but no prior multi-port retroperitoneal exposure. Surgical and perioperative outcomes of SP RAPN, using the LAA technique, were the primary endpoint of this study. As a secondary endpoint we evaluated the learning curve of this procedure. Results: Forty patients underwent SP RAPN. Median tumor size was 26 mm, with a median RENAL score of 5. Median warm ischemia time was 17 minutes and median estimated blood loss was 50 mL. No intraoperative complications, conversions, or positive surgical margins occurred. Three minor postoperative complications (7.5%) were recorded, with no grade ≥III events. Median length of stay was one night and median postoperative pain scores (VAS) at 12 and 24 hours were 0. Operative time, warm ischemia time and estimated blood loss showed improvement over successive cases, reflecting increased procedural efficiency. Conclusion: SP RAPN using the LAA technique is feasible and safe, even for a surgeon without prior SP or retroperitoneal experience. This first experience study demonstrated low morbidity, minimal postoperative pain, and early discharge. These findings support the adoption of SP RAPN via LAA as a viable option for minimally invasive nephron-sparing surgery, warranting validation in larger multicenter studies.
Keywords: Learning Curve, minimally invasive techniques, Partial Nephrectomy, Perioperative outcomes, Retroperitoneal, Robot-assisted surgery, Single-port robot
Received: 03 Nov 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Van Eecke, Grammens, De Kuyper, Verla, Ameye, Crivellaro and Decaestecker. 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: Henri Van Eecke
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