Modified three-arm port configuration for single-position, single-docking robotic nephroureterectomy: perioperative and oncological outcomes

Background: 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. Methods: 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. Results: 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. Conclusions: 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.