Comparison of efficacy between prone and lateral positions in retroperitoneal robotic-assisted partial nephrectomy for cT1 posterior renal hilar tumors

doi:10.3877/cma.j.issn.1674-3253.2026.04.009

Abstract

Abstract:

Objective

To investigate the safety and efficacy differences between prone and lateral positions for retroperitoneal robotic-assisted partial nephrectomy (rRAPN) in the treatment of cT₁ posterior renal hilar tumors, and to summarize the clinical experiences of prone position technique.

Methods

The clinical data of 51 patients with cT₁ posterior renal hilar tumors between January 2023 and January 2025 in our hospital were retrospectively analyzed. All patients underwent rRAPN by Da Vinci robotic system. The patients were divided into two groups based on surgical position: the prone position group (n=28) and the lateral position group (n=23). There were no significant differences between the two groups in terms of preoperative baseline characteristics, including age, gender, affected kidney side, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, age-adjusted Charlson Comorbidity Index (aCCI), preoperative hemoglobin (Hb), chronic kidney disease (CKD) staging, tumor diameter, R.E.N.A.L. score, and PADUA score (P>0.05). Perioperative outcomes and complications were compared between the two groups.

Results

All patients successfully completed surgery without conversion to open surgery, secondary procedures, or radical nephrectomy. Negative surgical margins were achieved in all cases. The prone position group had significantly shorter robotic docking time [(14.1±3.1) vs (17.3±2.7) min, P<0.001], operation time [(58.2±21.0) vs (82.6±33.6) min, P=0.004], renal artery dissection time [(6.2±3.0) vs (15.7±8.9) min, P<0.001], warm ischemia time [(25.9±8.8) vs (33.6±14.8) min, P=0.035], suturing time [(13.8±5.4) vs (20.1±10.2) min, P=0.011], and reduced estimated intraoperative blood loss [50.0 (27.5, 57.5) vs 100.0 (50.0, 200.0) mL, P=0.040] compared to the lateral position group. No significant differences were observed between the two groups in terms of postoperative 30 d changes in eGFR, 6-month changes in eGFR, postoperative hospital stay, 30 dcomplication rate, or "trifecta" achievement rate (P>0.05).

Conclusion

rRAPN in the prone position for cT₁ posterior renal hilar tumors is safe and effective. Compared with the traditional lateral position, the prone retroperitoneal approach is associated with shorter robotic docking time, operation time, renal artery dissection time, warm ischemia time, and suturing time, as well as alleviated intraoperative blood loss and surgical difficulty.

Key words: cT₁ posterior renal hilar tumor, Prone position, Partial nephrectomy, Robotic-assisted, Retroperitoneal, Lateral position

Xiao Yang, Haonan Chen, Qiang Cao, Hao Yu, Lingkai Cai, Zhengye Tan, Pengchao Li, Qiang Lv. Comparison of efficacy between prone and lateral positions in retroperitoneal robotic-assisted partial nephrectomy for cT₁ posterior renal hilar tumors[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(04): 426-433.

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References 27

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组别	例数	年龄[岁，(±s)]	性别(例)		患肾侧别(例)		BMI[kg/m²，(±s)]	ASA分级(例)		aCCI (±s)
组别	例数	年龄[岁，(±s)]	男	女	左	右	BMI[kg/m²，(±s)]	Ⅰ~Ⅱ	Ⅲ~Ⅳ	aCCI (±s)
俯卧位经背组	28	55.0±11.7	19	9	18	10	25.8±4.2	20	8	2.5±1.8
侧卧位经腰组	23	50.4±16.2	11	12	13	10	24.3±2.7	19	4	2.2±2.1
统计值		t=-1.197	χ²=2.092		χ²=0.319		t=-1.527	χ²=0.877		t=-0.520
P值		0.237	0.148		0.572		0.133	0.349		0.606
组别	术前Hb[g/L，(±s)]	术前Hct(±s)	术前CKD分期(例)		肿瘤最大径[cm，(±s)]	R.E.N.A.L.评分[分，(±s)	PADUA评分[分，(±s)]
组别	术前Hb[g/L，(±s)]	术前Hct(±s)	Ⅰ~Ⅱ	Ⅲ~Ⅳ	肿瘤最大径[cm，(±s)]	R.E.N.A.L.评分[分，(±s)	PADUA评分[分，(±s)]
俯卧位经背组	137.8±16.4	41.8±4.6	25	3	4.1±1.6	9.0±1.1	11.0±1.3
侧卧位经腰组	130.2±13.4	39.8±4.0	21	2	4.1±1.3	9.3±1.4	11.4±1.2
统计值	t=-1.791	t=-1.645	χ²=0		t=-0.002	t=0.654	t=1.079
P值	0.080	0.106	>0.999		0.998	0.516	0.286

组别	例数	年龄[岁，(±s)]	性别(例)		患肾侧别(例)		BMI[kg/m²，(±s)]	ASA分级(例)		aCCI (±s)
组别	例数	年龄[岁，(±s)]	男	女	左	右	BMI[kg/m²，(±s)]	Ⅰ~Ⅱ	Ⅲ~Ⅳ	aCCI (±s)
俯卧位经背组	28	55.0±11.7	19	9	18	10	25.8±4.2	20	8	2.5±1.8
侧卧位经腰组	23	50.4±16.2	11	12	13	10	24.3±2.7	19	4	2.2±2.1
统计值		t=-1.197	χ²=2.092		χ²=0.319		t=-1.527	χ²=0.877		t=-0.520
P值		0.237	0.148		0.572		0.133	0.349		0.606
组别	术前Hb[g/L，(±s)]	术前Hct(±s)	术前CKD分期(例)		肿瘤最大径[cm，(±s)]	R.E.N.A.L.评分[分，(±s)	PADUA评分[分，(±s)]
组别	术前Hb[g/L，(±s)]	术前Hct(±s)	Ⅰ~Ⅱ	Ⅲ~Ⅳ	肿瘤最大径[cm，(±s)]	R.E.N.A.L.评分[分，(±s)	PADUA评分[分，(±s)]
俯卧位经背组	137.8±16.4	41.8±4.6	25	3	4.1±1.6	9.0±1.1	11.0±1.3
侧卧位经腰组	130.2±13.4	39.8±4.0	21	2	4.1±1.3	9.3±1.4	11.4±1.2
统计值	t=-1.791	t=-1.645	χ²=0		t=-0.002	t=0.654	t=1.079
P值	0.080	0.106	>0.999		0.998	0.516	0.286

组别	例数	装机时间[min，(±s)]	手术时间[min，(±s)]	肾动脉解剖时间[min，(±s)]	热缺血时间[min，(±s)]	缝合肾脏时间[min，(±s)]	估计失血量[mL，M(Q)]	Hb变化值[g/L，(±s)]
俯卧位经背组	28	14.1±3.1	58.2±21.0	6.2±3.0	25.9±8.8	13.8±5.4	50.0 (27.5, 57.5)	-13.2±9.1
侧卧位经腰组	23	17.3±2.7	82.6±33.6	15.7±8.9	33.6±14.8	20.1±10.2	100.0 (50.0, 200.0)	-15.1±8.4
统计值		t=5.865	t=3.037	t=4.903	t=2.194	t=2.705	Z=-2.050	t=-0.777
P值		<0.001	0.004	<0.001	0.035	0.011	0.040	0.441
组别	Hct变化值[%，(±s)]	术后30 d eGFR变化值[ml/min/1.73 m²，(±s)]	术后6个月eGFR变化值[ml/min/1.73m²，(±s)]	输血(例)	切缘阳性/术中转开放手术/术中转根治性肾切除/二次手术(例)
俯卧位经背组	-4.6±3.1	-9.6±11.8	-11.8±12.0	0	0
侧卧位经腰组	-4.7±2.6	-11.0±12.9	-11.1±10.9	3	0
统计值	t=-0.152	t=-0.399	t=0.194	χ²=1.882	-
P值	0.880	0.692	0.847	0.170	-
组别	术后住院时间[d，(±s)]	术后并发症(例)			病理类型(例)			达到"三连胜"(例)
组别	术后住院时间[d，(±s)]	无	Ⅰ~Ⅱ	Ⅲ	透明细胞癌	血管平滑肌脂肪瘤	其他	达到"三连胜"(例)
俯卧位经背组	4.3±1.0	24	3	1	23	1	4	23
侧卧位经腰组	5.8±4.5	18	3	2	12	6	5	19
统计值	t=1.659	-			-			χ²=0
P值	0.104	0.745			0.031			>0.999

组别	例数	装机时间[min，(±s)]	手术时间[min，(±s)]	肾动脉解剖时间[min，(±s)]	热缺血时间[min，(±s)]	缝合肾脏时间[min，(±s)]	估计失血量[mL，M(Q)]	Hb变化值[g/L，(±s)]
俯卧位经背组	28	14.1±3.1	58.2±21.0	6.2±3.0	25.9±8.8	13.8±5.4	50.0 (27.5, 57.5)	-13.2±9.1
侧卧位经腰组	23	17.3±2.7	82.6±33.6	15.7±8.9	33.6±14.8	20.1±10.2	100.0 (50.0, 200.0)	-15.1±8.4
统计值		t=5.865	t=3.037	t=4.903	t=2.194	t=2.705	Z=-2.050	t=-0.777
P值		<0.001	0.004	<0.001	0.035	0.011	0.040	0.441
组别	Hct变化值[%，(±s)]	术后30 d eGFR变化值[ml/min/1.73 m²，(±s)]	术后6个月eGFR变化值[ml/min/1.73m²，(±s)]	输血(例)	切缘阳性/术中转开放手术/术中转根治性肾切除/二次手术(例)
俯卧位经背组	-4.6±3.1	-9.6±11.8	-11.8±12.0	0	0
侧卧位经腰组	-4.7±2.6	-11.0±12.9	-11.1±10.9	3	0
统计值	t=-0.152	t=-0.399	t=0.194	χ²=1.882	-
P值	0.880	0.692	0.847	0.170	-
组别	术后住院时间[d，(±s)]	术后并发症(例)			病理类型(例)			达到"三连胜"(例)
组别	术后住院时间[d，(±s)]	无	Ⅰ~Ⅱ	Ⅲ	透明细胞癌	血管平滑肌脂肪瘤	其他	达到"三连胜"(例)
俯卧位经背组	4.3±1.0	24	3	1	23	1	4	23
侧卧位经腰组	5.8±4.5	18	3	2	12	6	5	19
统计值	t=1.659	-			-			χ²=0
P值	0.104	0.745			0.031			>0.999

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Comparison of efficacy between prone and lateral positions in retroperitoneal robotic-assisted partial nephrectomy for cT₁ posterior renal hilar tumors

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