Single-port robotic nephroureterectomy via retroperitoneal supine anterior approach: Step-by-step technique

Introduction & Objectives Radical nephroureterectomy is the standard treatment for high-risk, non-metastatic upper tract urothelial carcinoma (UTUC). The advent of the da Vinci single-port (SP) robotic platform has renewed interest in retroperitoneal approaches. We describe a step-by-step technique for single-port robot-assisted nephroureterectomy (SP-RANU) via a supine anterior retroperitoneal approach and provide context from an early institutional experience. Materials & Methods An 82-year-old male with biopsy-proven low-grade UTUC of the left upper tract underwent SP-RANU through a supine anterior retroperitoneal access. A single incision was used to place the SP access port and a side-car AirSeal trocar. Key steps included early ureteral control, hilar dissection, distal ureter and bladder cuff excision, and en bloc specimen removal without patient repositioning or robotic re-docking. Results In the index case, console time was 298 min with an estimated blood loss of 350 mL and no intraoperative or postoperative complications. The patient was discharged on postoperative day 1 with negative surgical margins. In our early institutional experience of six SP-RANU cases, procedures were completed without intraoperative complications, median hospital stay was short, and perioperative morbidity was limited. Negative surgical margins were achieved in organ-confined disease, with no local recurrences during short-term follow-up. Conclusion SP-RANU via a supine anterior retroperitoneal approach is a feasible and safe technique in selected patients. Early institutional outcomes are encouraging, although larger series and longer follow-up are required to confirm reproducibility and oncologic durability.