Feasibility, safety, and outcomes of single-port robot assisted nephroureterectomy: early single center experience

Abstract

Aim: Upper tract urothelial carcinoma (UTUC) is an aggressive malignancy historically managed with radical nephroureterectomy (NU). While multiport robot-assisted NU (MP-RANU) offers advantages over open surgery, data on single-port RANU (SP-RANU) remains limited. We aim to describe a single-institution’s experience with SP-RANU and evaluate its feasibility, safety, and early outcomes.

Methods: A retrospective review of SP-RANU procedures completed at a tertiary academic center was conducted. Demographic information, clinical data, tumor characteristics, operative details, and postoperative outcomes were recorded.

Results: Between July 2022 and March 2025, six patients underwent SP-RANU [median age 75 years, interquartile range (IQR) 68-77]. Median operative time was 297 min (IQR 248-368), median estimated blood loss was 325 mL (IQR 213-625), and no intraoperative complications were reported. Median hospital length of stay (LOS) was 1.5 days (IQR 1-5). Two patients experienced Clavien-Dindo grade II complications. Five patients achieved negative oncologic margins, one patient underwent SP-RANU for non-oncologic indications, and one patient developed distant nodal metastasis noted after surgery. There was a median reduction of 9 mL/min/1.73 m² in estimated glomerular filtration rate (eGFR) between pre-op and discharge levels. Post-operatively, patients required a median of 77 morphine milligram equivalents (MMEs) for pain control, and two patients were discharged without narcotics.

Conclusion: SP-RANU offers regionalization of surgery, low intraoperative morbidity, decreased opioid requirements, short LOS, and promising early perioperative outcomes in carefully selected patients. This data supports SP-RANU as a viable minimally invasive surgical option, with need for further evaluation in a larger comparative cohort.

Keywords

Single port / nephroureterectomy / robotic surgery / urothelial cell carcinoma

References

[1] Barton GJ,Inman BA.The nephroureterectomy: a review of technique and current controversies.Transl Androl Urol2020;9:3168-90 PMCID:PMC7807352

[2] Veccia A,Francavilla S.Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases.World J Urol2020;38:845-52

[3] Ditonno F,Wu Z.Robot-assisted nephroureterectomy: surgical and mid-term oncological outcomes in over 1100 patients (ROBUUST 2.0 collaborative group).BJU Int2024;134:967-75

[4] Ditonno F,Franco A.The single port robotic surgical “toolbox”: a primer for beginners.Minerva Urol Nephrol2024;76:635-9

[5] Pellegrino AA,Crivellaro S.Application of the single-port robotic platform during radical nephroureterectomy for upper tract urothelial carcinoma: feasibility of the single-port robot in the multi-quadrant setting.Transl Androl Urol2023;12:1469-74 PMCID:PMC10560342

[6] Veccia A,Derweesh I.Single-stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes.Minerva Urol Nephrol2022;74:233-41

[7] Bang S,Park YH.Single-port robotic retroperitoneal nephroureterectomy with bladder cuff excision: comparative cohort study with multi-port transperitoneal approach.J Endourol2026;40:547-52

[8] Moschovas MC,Onol FF.Single-port technique evolution and current practice in urologic procedures.Asian J Urol2021;8:100-4 PMCID:PMC7859361

[9] Izzo A,Grimaldi G.Single-port robot-assisted nephroureterectomy via a supine anterior approach: step-by-step technique.BJU Int2025;135:535-8 PMCID:PMC11842893

[10] Pugh J,Willis D,Hemal A.Perioperative outcomes of robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi-institutional series.BJU Int2013;112:E295-300

[11] Ditonno F,Licari LC.Implementation of single-port robotic urologic surgery: experience at a large academic center.J Robot Surg2024;18:119

[12] Bignante G,Lasorsa F.Robotic-assisted surgery for the treatment of urologic cancers: recent advances.Expert Rev Med Devices2024;21:1165-77

[13] Rajan K,Geraghty R.Oncological efficacy of robotic nephroureterectomy vs. open and laparoscopic nephroureterectomy for suspected non-metastatic UTUC-A systematic review and meta-analysis.Cancers2023;15:4926 PMCID:PMC10605607

[14] Kacew A.FGFR3 alterations in the era of immunotherapy for urothelial bladder cancer.Front Immunol2020;11:575258 PMCID:PMC7674585

[15] Guercio BJ,Teo MY.Clinical and genomic landscape of FGFR3-altered urothelial carcinoma and treatment outcomes with erdafitinib: a real-world experience.Clin Cancer Res2023;29:4586-95 PMCID:PMC11233068

[16] Huang J,Wang X.3075P Circulating and urine tumor DNA dynamics predict minimal residual disease and guide adjuvant therapy in locally advanced upper tract urothelial carcinoma (CURATE-UTUC): a multicenter prospective longitudinal cohort study.Ann Oncol2025;36:S1488-9

[17] Hayashi Y.Toward urinary cell-free DNA-based treatment of urothelial carcinoma: a narrative review.Transl Androl Urol2021;10:1865-77 PMCID:PMC8100839