Transperitoneal Versus Retroperitoneal Robotic-Assisted Partial Nephrectomy in Patients with Obesity

Kennedy E. Okhawere, Jordan Miller Rich, Alp Tuna Beksac, Laura Zuluaga, Indu Saini, Burak Ucpinar, Joshua Levieddin, Iretiayo T. Joel, Anthony Deluxe, Michael D. Stifelman, Simone Crivellaro, Ronney Abaza, Daniel D. Eun, Akshay Bhandari, Ashok K. Hemal, James Porter, Ahmed Mansour, Phillip M. Pierorazio, Osama Zaytoun, Ketan K. Badani

Research output: Contribution to journalArticlepeer-review


Introduction: We aim to compare transperitoneal (TP) and retroperitoneal (RP) robotic partial nephrectomy (RPN) in obese patients. Obesity and RP fat can complicate RPN, especially in the RP approach where working space is limited. Materials and Methods: Using a multi-institutional database, we analyzed 468 obese patients undergoing RPN for a renal mass (86 [18.38%] RP, 382 [81.62%] TP). Obesity was defined as body mass index ≥30 kg/m2∗. A 1:1 propensity score matching was performed adjusting for age, previous abdominal surgery, tumor size, R.E.N.A.L nephrometry score, tumor location, surgical date, and participating centers. Baseline characteristics and perioperative and postoperative data were compared. Results: In the propensity score-matched cohort, 79 (50%) TP patients were matched with 79 (50%) RP patients. The RP group had more posterior tumors (67 [84.81%], RP versus 23 [29.11%], TP; P < .001), while the other baseline characteristics were comparable. Warm ischemia time (interquartile range; 15 [10, 12], RP versus 14 [10, 17] minutes, TP; P = .216), operative time (129 [116, 165], RP versus 130 [95, 180] minutes, TP; P = .687), estimated blood loss (50 [50, 100], RP versus 75 [50, 150] mL, TP; P = .129), length of stay (1 [1, 1], RP versus 1 [1, 2] day, TP; P = .319), and major complication rate (1 [1.27%], RP versus 3 [3.80%], TP; P = .620) were similar. No significant difference was observed in positive surgical margin rate and delta estimated glomerular filtration at follow-up. Conclusion: TP and RP RPN yielded similar perioperative and postoperative outcomes in obese patients. Obesity should not be a factor in determining optimal approach for RPN.

Original languageEnglish (US)
Pages (from-to)835-840
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Issue number9
StatePublished - Sep 1 2023


  • obesity
  • partial nephrectomy
  • perioperative outcome
  • retroperitoneal
  • robotic surgery
  • transperitoneal

ASJC Scopus subject areas

  • Surgery


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