Initial Experience of Partial Nephrectomy and Retroperitoneal Organ Surgery using Supine Anterior Retroperitoneal Access (SARA) with the da Vinci SP Robotic System: Initial descriptive analysis

Purpose: This study aimed to describe the initial experience and perioperative outcomes of partial nephrectomy (PN) and other retroperitoneal organ surgeries using the supine anterior retroperitoneal access (SARA) technique with the da Vinci SP robotic system. Materials and Methods: Between December 2023 and December 2024, 35 retroperitoneal surgeries, including 25 PNs, were performed via SARA using a single-port robotic platform. The SARA approach utilizes anterior anatomical landmarks in the supine position to access retroperitoneal organs. Perioperative data, including operative time, warm ischemia time, estimated blood loss (EBL), postoperative renal function, length of stay (LOS), pain scores, and complications, were retrospectively reviewed. Results: Among 34 patients (mean age 60.3 years), PN was the most common procedure (73.5%). The mean tumor size for PN was 3.5 cm, and all were staged cT1a–b. There were no conversions to open surgery, no positive margins, and no major complications. Mean operative time was 200.6 minutes, warm ischemia time 21.3 minutes, and EBL 366.6 mL. Postoperative LOS averaged 7.1 days, and pain scores were well controlled (mean 2.4). sCr and hemoglobin changes were within acceptable limits. The SARA technique was also successfully applied to adrenalectomy, ureterectomy, and retroperitoneal mass excisions. Conclusions: SARA using the da Vinci SP platform is a feasible and safe approach for retroperitoneal surgeries, including PN and adrenalectomy. It offers advantages in patient positioning, surgical ergonomics, and recovery. Further studies are warranted to validate its role compared to traditional approaches and to define learning curve parameters.