Novel prone retroperitoneal robotic-assisted approach for bilateral partial nephrectomy: a case report

Introduction and importance: Partial nephrectomy is the standard surgical technique for the management of early-stage renal neoplasms. Bilateral synchronous sporadic renal tumors are a rare subtype of renal tumors, for which no consensus has been reached on the optimal surgical strategy. Case presentation: A 73-year-old man was diagnosed with bilateral renal masses. Owing to a history of prior abdominal surgeries and underlying medical conditions, including ankylosing spondylitis, we herein report for the first time the performance of robotic-assisted one-stage bilateral partial nephrectomy in the prone position. No severe intraoperative or postoperative complications or renal failure were observed, and the patient achieved a satisfactory recovery at the 3-month postoperative follow-up. Clinical discussion: Conventional partial nephrectomy via either transperitoneal or retroperitoneal approaches has been performed in the lateral decubitus position. For patients with bilateral renal tumors, this approach necessitates intraoperative repositioning, while prolonged lateral decubitus may compromise respiratory function and cause compression of peripheral nerves. In contrast, the prone position approach not only resolves these issues but also simplifies the surgical procedure and provides greater benefits to patients. Conclusion: Prone retroperitoneal robotic assisted partial nephrectomy is a novel approach for the management of BSSRCC, and expanded samples and large-scale clinical studies are warranted to confirm the safety and feasibility of this surgical technique in future investigations.