Modified three-arm port configuration for single-position, single-docking robotic nephroureterectomy: perioperative...

Robot-assisted nephroureterectomy (RANU) often requires intraoperative repositioning. Standard single-docking techniques use a four-arm port layout, which may not be optimal for patients with smaller body habitus. Therefore, this study aimed to evaluate the feasibility and safety of a modified three-arm port configuration for single-position, single-docking RANU.

We retrospectively analyzed 10 consecutive patients with upper tract urothelial carcinoma (UTUC) who underwent RANU using this modified configuration at a single center (Oct 2023-Oct 2024). The procedure was performed with the Da Vinci Xi system, utilizing a three-arm triangular port placement designed to minimize robotic arm collision. The affected kidney, entire ureter, and bladder cuff were excised en bloc.

All procedures were completed successfully without repositioning or conversion. Mean operative time was 218 min (range, 170-290 min). The mean postoperative hemoglobin decrease was 9.3 g/L (range, 1-19 g/L). The average postoperative hospital stay was 8.7 days (range, 6-10 days). One patient (10%) had a Clavien-Dindo grade I complication (lymphatic leakage). All surgical margins were negative. Pathological stages were pT1 (30%), pT2 (60%), and pT3 (10%). At a median follow-up of 9.5 months, 1 patient (10%) experienced bladder recurrence.

The modified three-arm port configuration appears to be a feasible and safe approach for single-docking RANU, particularly suited to patients with smaller body frames. It demonstrates satisfactory perioperative and initial oncological outcomes in this preliminary series. Furthermore, the three-arm technique may potentially reduce operative costs. This technique may offer a practical minimally invasive option for UTUC, though validation in larger cohorts is warranted.