Robot-Assisted Right Hemicolectomy for Ascending Colon Cancer in a Kidney Transplant Recipient: A Case Report.

During colorectal surgery, the renal allograft and transplanted ureter may constrain port placement and instrument movement; therefore, kidney transplant recipients require careful planning. Here, we report a case of robot-assisted right hemicolectomy for ascending colon cancer adjacent to an ipsilateral renal allograft. A 62-year-old woman underwent deceased-donor kidney transplantation 16 years prior, with a renal allograft placed in the right iliac fossa. Colonoscopy revealed a near-circumferential lesion in the ascending colon, and biopsy revealed a well- to moderately differentiated tubular adenocarcinoma with focal mucinous components. Non-contrast computed tomography (CT) showed that the tumor was adjacent to the renal allograft, with no lymph nodes or distant metastases. Preoperative CT was used to assess the anatomical relationships between the tumor, renal allograft, and transplanted ureter. Robot-assisted right hemicolectomy was performed using the Hugo™ RAS system (Medtronic plc, Minneapolis, MN, USA). Arm 1 port was shifted medially to avoid the renal allograft, and robotic arm clearance and instrument mobility were confirmed before dissection. The procedure was completed without any conversion. The operative time was three hours and 24 minutes, and the estimated blood loss was less than 10 mL. The final pathology revealed pT3N0M0 stage IIA disease with negative margins and no lymph node metastases. No postoperative complications, graft rejection, or graft dysfunction were observed. This case suggests that robot-assisted right hemicolectomy may be feasible in selected kidney transplant recipients when patient-specific anatomy is assessed preoperatively, port placement is individualized, and robotic arm clearance and instrument mobility are confirmed.