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Robotic technology and new surgical adjuncts are continually evolving to aid the operating surgeon and improve patient outcomes. Retroperitoneal access in renal surgery has clear benefits over traditional transperitoneal surgery with robotics augmenting the surgeon’s ability to operate in this anatomically confined space. Traditionally, the retroperitoneal approach was reserved for patients with posterior or laterally located tumors, or in patients with hostile abdomens; however, more streamlined surgical robots, improvements in port placement and increased utilization of the retroperitoneal approach has meant that the vast majority of small renal masses can be safely accessed via the retroperitoneum. This chapter aims to explore this paradigm shift further, while also exploring the use of added technologies and variations in surgical techniques.
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