Non‐Right Renal Vein Occlusion: A Side Clamp Two‐Step Technique for Robot‐Assisted Laparoscopic Transposition of the Left Renal Vein in Nutcracker Syndrome

OBJECTIVE: To evaluate the feasibility of a novel robotic-assisted laparoscopic technique-side clamp two-step vascular method-for left renal vein (LRV) transposition in nutcracker syndrome (NCS). METHODS: Between May and December 2023, three male NCS patients (median age: 14 years) underwent robot-assisted LRV transposition using the Di's technique. The key procedure included a side clamp two-step technique to selectively occlude the infrarenal inferior vena cava and LRV without right renal vein manipulation. Surgical outcomes, including operative time, blood loss, anastomosis duration, and postoperative complications, were retrospectively analysed. RESULTS: All procedures were successfully completed. Median operative time was 125 min, with LRV anastomosis completed in 23 min. Postoperative imaging confirmed the resolution of LRV compression, with pressure gradients reduced to < 3 mmHg. Symptoms resolved completely within 4 weeks. CONCLUSIONS: The robotic-assisted side clamp two-step technique offers a minimally invasive alternative for LRV transposition in NCS, minimising vascular dissection and preserving right renal venous flow. TRIAL REGISTRATION: This clinical trial has been registered in the Chinese Clinical Trial Registry (ChiCTR, registration number: ChiCTR2500099335).