Retroperitoneal Robotic
Partial Nephrectomy
A kidney-sparing approach reached from behind the abdomen rather than through it — Mr Sri's default technique for kidney cancer surgery, and one of the highest-volume practices of its kind in Europe.
Reaching the kidney from behind, not through the abdomen
Most kidney cancer surgery is performed transperitoneally — through the front of the abdomen. Mr Sri's default approach instead reaches the kidney retroperitoneally: entering directly through the back of the abdomen, behind the abdominal lining, without opening the abdominal cavity or disturbing the bowel at all.
Many kidney tumours sit on the back surface of the organ, against the psoas muscle — the retroperitoneal route approaches that area directly. Even for tumours on the outer or upper pole, this route can give faster control of the kidney's blood vessels and a more stable field for reconstruction once the tumour is removed.
Retroperitoneal vs. transperitoneal partial nephrectomy
| Feature | Transperitoneal (standard) | Retroperitoneal |
|---|---|---|
| Surgical route | Through the front of the abdomen | Through the back, behind the abdominal lining |
| Bowel handling | Bowel is mobilised to access the kidney | Not required — abdominal cavity not entered |
| Best suited to | Anterior tumours, wide working space needed | Posterior and lower-pole tumours |
| Vessel control | Achieved after bowel mobilisation | Often faster — direct access to the renal hilum |
| Gut recovery | Slower, more post-operative bloating | Faster, less bloating |
| Availability | Widely practised | Performed by a small group of European surgeons |
Suitability is assessed by tumour position and anatomy
Who may be suitable
Retroperitoneal access is particularly well suited to tumours on the back, outer, or upper pole of the kidney. Suitability also depends on tumour size, RENAL score, and prior abdominal surgery. Mr Sri accepts complex and high-risk tumours for kidney-preserving surgery via this route, including cases declined elsewhere.
Current urology guidelines strongly support kidney-sparing surgery for many renal masses — typically tumours up to 4cm, and a good number up to 7cm where the anatomy is favourable.
Worth asking at consultation
- Is my tumour's position suitable for the retroperitoneal approach?
- Can my kidney be preserved, or is radical nephrectomy the only option?
- What is my tumour's RENAL score, and how does that affect the plan?
- What does recovery look like after this approach specifically?
- How does kidney preservation affect my long-term kidney function?
Discuss your kidney tumour with Mr Sri
Tertiary referrals welcomed. Same-week appointments across four London locations.