Robot-Assisted Laparoscopic Retroperitoneal Renal Artery Aneurysm Repair: A Rare Case Report and Literature Review.

INTRODUCTION: The treatment of renal artery aneurysms (RAAs) includes surgical repair and endovascular techniques. Surgical repair is divided into open surgery repair and laparoscopic surgery repair. Laparoscopic RAA has fewer postoperative complications than open surgery. Some experiences with robotic RAA repair via transperitoneal access have been recently reported. However, no report could be found on the treatment of retroperitoneal RAA with the da Vinci robot-assisted surgery thus far.

CASE PRESENTATION: Here, the surgical management of an 8.6-mm right-sided RAA via robot-assisted laparoscopic retroperitoneal approach in a 58-year-old man who presented with flank discomfort is reported. The aneurysm was resected, and the renal artery was reconstructed. The total operative time was 2 h with a warm ischemia time of 25 min, and the estimated surgical blood loss was 50 mL. The patient resumed a regular diet on postoperative day 2, and the hospital stay lasted 5 days. No intraoperative nor postoperative morbidity was reported. Follow-up imaging and functional analysis demonstrated resolution of the aneurysm and preservation of renal function after 2.5 months.

CONCLUSIONS: Robot-assisted laparoscopic retroperitoneal RAA repair is flexible and safe. The greatest advantage of retroperitoneal surgery is direct access to the renal artery. Furthermore, it could reduce the injury in the abdominal organs and avoid abdominal adhesion. This approach may also allow for improved postoperative recovery, reduce the morbidity correlated with transperitoneal RAA, and thus may be considered as an alternative to transperitoneal surgery for RAAs in the future.