Robotic-Assisted Laparoscopic Partial Nephrectomy for Multiple Synchronous Renal Tumors in a Solitary Kidney: A Case Report.

We report the case of a 65-year-old female with multiple synchronous clear cell renal cell carcinomas (ccRCC) in a solitary kidney following prior radical nephrectomy of the contralateral side, presenting with five tumors ranging from 0.8 cm to 3.6 cm in size, distributed across all segments of the kidney as well as on both the anterior and posterior surfaces. Due to the complex tumor distribution, a patient-specific 3D model was created for preoperative planning to precisely assess the spatial relationship of the tumors to the main renal vessels, intrarenal vasculature, collecting system, and ureter. Given the pre-existing chronic kidney disease, nephron-sparing surgery was performed using a robotic-assisted laparoscopic approach, with intraoperative ultrasound and selective vascular clamping additionally employed to further optimize the resection strategy. All tumors were completely resected with negative margins. The postoperative course was uneventful; renal function remained stable, and dialysis was not required. The patient has remained cancer-free during follow-up. This case highlights the technical feasibility and clinical value of nephron-sparing surgery even in multifocal, anatomically complex renal tumors. The integration of advanced imaging modalities and individualized 3D surgical planning can improve oncological outcomes while preserving renal function, emphasizing the importance of a personalized, technology-assisted approach in contemporary renal tumor surgery.