Robot-Assisted Nephroureterectomy for Urothelial Carcinoma in a Horseshoe Kidney: A Case Report

The horseshoe kidney is the most common renal fusion anomaly, and its unique anatomical configuration and aberrant vasculature present significant surgical challenges, particularly in malignant conditions such as urothelial carcinoma. We report a case of robot-assisted right nephroureterectomy with the da Vinci Xi® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) in a patient with right lower ureteral cancer associated with a horseshoe kidney. The procedure was completed robotically using the da Vinci Xi® system in 207 minutes with minimal blood loss. The pathological diagnosis was high-grade urothelial carcinoma (pT2) with negative surgical margins and one positive lymph node near the ureteral tumor (N1). The postoperative course was uneventful, and no recurrence was observed at 24 months. This case demonstrates the safety and efficacy of robot-assisted surgery for upper tract urothelial carcinoma (UTUC) in patients with complex renal anomalies such as a horseshoe kidney.