Abstract: A novel intracorporeal minimally invasive procedure for robot assisted laparoendoscopic single-site partial nephrectomy.

A clinical study presents an innovative intracorporeal minimally invasive surgical procedure, robotic laparoendoscopic single-site ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (LESS-HPN), specifically designed for the surgical management of T1-stage renal tumors. This advanced surgical paradigm perfectly combines robotic single-port minimally invasive surgery with precise ultrasound-guided intravascular occlusion technology. The procedure adopts the professional Freeport access system independently developed by Ningbo SensCure Biotechnology, establishing a standardized single-site surgical channel through a minimal 4.5–5.0 cm skin incision, which significantly optimizes both cosmetic and intracorporeal minimally invasive effects.

(A) After a Freeport (Ningbo SensCure Biotechnology) was inserted. One 8-mm optic trocar and two 8-mm trocars for robotic instruments were placed at 12o’clock, 3o’clock, and 9o’clock direction, respectively, and two assistant trocars were placed at the same time. (B) da Vinci XI robot was docked.

Through the two assistant channels on the Freeport, the monitoring area of the LUS probe was able to cover a large area of abdominal organsand vessels . After locating the tumor with LUS, the perirenal fat was directly incised to expose the renal tumor border. Unlike conventional PN, the paracolic sulci, most of the perirenal fat, and renal hilum structures did not need to be dissected.

Through two assistant trocars, the monitoring area of the LUS probe can cover the large intra-abdominal vessels. (A) The LUS was swept to the long axis of iliac vessels through the assistant trocar caudal. (B) Through the assistant trocar caudal, LUS swept the long axis of the abdominal aorta. (C) Through the assistant trocar caudal, LUS swept the long axis of the abdominal aorta and renal artery orifice. (D) Through the assistant trocar cephalad, LUS swept to the long axis of the renal artery

Compared with traditional robotic partial nephrectomy and conventional single-site laparoscopic surgery, LESS-HPN abandons complicated renal hilar dissection and routine renal artery clamping, which greatly simplifies intraoperative operations and reduces instrument collision risks. With real-time laparoscopic ultrasound monitoring, a Fogarty balloon catheter is accurately positioned to occlude the tumor-supplying main renal artery, branch arteries or accessory renal arteries. Color Doppler flow imaging and contrast-enhanced ultrasound are applied to confirm complete regional blood flow blockade before tumor resection.

The clinical data demonstrated excellent surgical outcomes in 10 enrolled patients. All cases successfully completed LESS-HPN without conversion to open or multi-port surgery and without additional auxiliary ports. The mean operative time was 103.3±11.1 minutes, the warm ischemia time was well controlled at 21.0±2.7 minutes, and the average estimated blood loss was only 42.0±22.5 ml. During a median follow-up of 10.5 months, no adverse events including tumor recurrence, distant metastasis or patient mortality were observed.

Assisted by the SensCure Freeport system, the optimized LESS-HPN technique effectively lowers surgical difficulty, avoids unnecessary tissue damage, and ensures reliable oncological safety and superior renal function protection. As a safe, feasible and minimally invasive surgical solution, it provides a promising alternative for clinical precise treatment of early-stage renal tumors.

Source: Robotic laparoendoscopic single-site ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (LESS-HPN): a prospective pilot stud