Transabdominal lumbar approach (TALA) versus retroperitoneal approach for robot-assisted renal surgery: a prospective randomised controlled trial
In brief
Transabdominal lumbar approach cuts time to renal artery identification by 16 minutes
In a prospective randomized trial of 40 patients, the new transabdominal lumbar (TALA) technique reached the renal artery in a median of 38 minutes versus 54 minutes with the standard retroperitoneal route, saving about 16 minutes. Peri-operative safety was similar, with three grade III-IV complications (7.5%) overall. The faster exposure may streamline robot-assisted nephrectomy, but larger studies are needed to confirm broader benefits.
- Journal
- World journal of urology (Q1)
- Published
- 15 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Uwe Bieri, Franziska Heining, Aydin Javadov, Marie Lork, Philipp Maletzki, Jean-Pascal Adank, et al.
- PMID
- 42742659
- DOI
- 10.1007/s00345-026-06757-8
Why clinicians should know about it
Abstract
PURPOSE: Common robotic nephrectomy approaches access the kidney via transperitoneal (TP) or retroperitoneal (RP) routes, each with distinct trade-offs. We developed the transabdominal lumbar approach (TALA), combining advantages of both accesses with improved visualisation and strategic trocar placement, and compared it with conventional RP in a prospective randomised controlled trial using technique-oriented intraoperative endpoints. METHODS: In this single-centre, prospective, open-label RCT, 40 patients were randomised to TALA (n = 18) or conventional RP (n = 22). Eligible patients were ≥ 18 years with a renal tumour or non-functional kidney requiring robot-assisted total or partial nephrectomy. Exclusions included prior surgery on the affected kidney, renal vein tumour thrombus, and pregnancy. Both groups were followed for 30 days. The primary endpoint was time from first skin incision to renal artery identification. RESULTS: TALA achieved a median time saving of 16 min compared to conventional RP (38 vs. 54 min, p = 0.001). Perioperative safety was comparable between groups, with three patients (7.5%) experiencing Clavien-Dindo grade III-IV complications. CONCLUSIONS: TALA met its primary endpoint with a significantly shorter time to renal artery identification than conventional RP access, and improving perceived surgical exposure and instrument handling.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.