Pure Retroperitoneal Robot-Assisted Radical Nephroureterectomy (RANU): Initial Experience Using the Hinotori Surgical Robot System.

BACKGROUND

Upper tract urothelial carcinoma (UTUC) often requires nephroureterectomy. The retroperitoneal robotic approach, particularly using the hinotori system, may offer advantages, especially for smaller-framed patients.

METHODS

Five UTUC patients (≤ 162 cm) underwent pure retroperitoneal robot-assisted nephroureterectomy (RANU) using the hinotori system (July-December 2024). Standardized trocar placement was used without port relocation. Outcomes included operative time, re-docking, and complications.

RESULTS

Median patient age was 82 years. All surgeries were completed without peritoneum opening, conversion to open surgery, or major complications. Mean operative time was 257 min, with re-docking averaging 18 min. All cases achieved negative margins, and no readmissions occurred within 30 days.

CONCLUSIONS

Pure retroperitoneal RANU using the hinotori system is safe and feasible, particularly for smaller patients. This approach minimizes procedural interference and may serve as an alternative to transperitoneal nephroureterectomy. Further studies are needed to evaluate oncological outcomes and refine surgical techniques.