First report of transumbilical robotic-assisted single-port laparoscopic partial nephrectomy using a domestic Shurui^® robotic system: a report of two cases

Abstract

Background

Small renal masses (SRMs) (≤4 cm) now comprising >70% of newly detected renal cancers. Nephron-sparing partial nephrectomy (PN) is guideline-recommended, and robotic surgery is becoming increasingly popular. However, the existing single-port (SP) platform is constrained by economic reasons and regional regulatory barriers. This report presents the first two clinical cases of transumbilical SP robotic-assisted PN (SP-RAPN) using the domestically developed Shurui^® robotic system, aiming to evaluate the feasibility, safety, and early outcomes of this novel surgical approach.

Case Description

Two patients (a 65-year-old woman and a 56-year-old man) with SRMs underwent transumbilical SP-RAPN via a 3 cm peri-umbilical incision within the natural skin crease. The RENAL (radius, exophytic, nearness, anterior/posterior, and location) nephrometry scores of these two cases were 5 and 6. Intraoperative data, including docking time, operative duration, estimated blood loss (EBL), warm ischemia time (WIT), and postoperative pain scores, were prospectively recorded. Both procedures were successfully completed without conversion to open or multi-port surgery. Docking time was 4 minutes in both cases; console time was 112 and 135 minutes; EBL was 100 and 50 mL; WIT was 24 and 21 minutes; and postoperative length of stay was 5 and 6 days, respectively. No Clavien-Dindo grade ≥ II complications occurred. Postoperative pain intensity assessed with the numeric rating scale (NRS) was ≤2/10 at 24 hours and decreased to 0–1/10 by postoperative day 2. Pathological report of renal clear cell carcinoma [World Health Organization (WHO) grade 2], with negative margins in both cases.

Conclusions

Early outcome shows that transumbilical SP-RAPN using the Shurui^® robotic system is technically feasible, and associated with favorable perioperative outcomes, minimal postoperative pain, satisfactory cosmetic results, and adequate safety profile, while short-term oncological and functional outcomes appear acceptable.

Highlight box.

Key findings

• Transumbilical single-port robotic-assisted partial nephrectomy (SP-RAPN) was successfully performed using a domestic Shurui^® robotic system.

What is known and what is new?

• The domestic Shurui^® robotic system was developed and has performed different kinds of surgery successfully.

• This is the first report of transumbilical RAPN performed with the Shurui^® SP robotic system.

What is the implication, and what should change now?

• Early outcome shows that transumbilical SP-RAPN using the Shurui^® robotic system is technically feasible, and associated with favorable perioperative outcomes, minimal postoperative pain, and satisfactory cosmetic results. For patients with high aesthetic requirements for wounds, transumbilical surgery using the Shurui^® robotic system may be considered.

Introduction

Small renal masses (SRMs) ≤4 cm now account for more than 70% of newly detected renal cell carcinomas (1). Current guidelines recommend nephron-sparing partial nephrectomy (PN) whenever technically feasible, because it confers equivalent oncological control and better long-term renal function compared with radical nephrectomy (2). The da Vinci^® robotic platform has popularized a minimally invasive approach, the Food and Drug Administration (FDA) granted approval for the single-port (SP^®) system to be utilized in urology patients in 2018 (3). Yet, the recently introduced SP systems are still available in only a handful of high-volume centers, mainly because of economic reasons and regional regulatory barriers (4). In China, the domestic Shurui^® robotic surgical system obtained National Medical Products Administration (NMPA) approval in 2023 (5) and has since been utilized for nephrectomy, pyeloplasty, and prostatectomy (6-8). However, its application to transumbilical SP robotic-assisted PN (SP-RAPN) has not been reported. We describe the first two cases of SRMs treated with SP-RAPN using the Shurui^® robot. We present this article in accordance with the CARE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-aw-783/rc).

Case presentation

The Shurui^® robotic surgical system

The Shurui^® robotic surgical system (Model SR-ENS-600; SHURUI Robotics, Beijing, China) is a domestically developed SP platform approved by the NMPA in 2023. It comprises a remote console equipped with a three-dimensional (3D) 4K monitor, a surgical cart carrying an auxiliary high-definition (HD) screen for the bedside assistant, a four-arm operating cart, and reusable, deformable robotic instruments that enable 135° full-direction bending within an 8 mm port while maintaining >17 N payload capacity (Figure 1).

Figure 1.

The Shurui^® robotic surgical system. (A) Remote console. (B) Operating cart. (C) Deformable robotic instruments.

Ethics approval and informed consent

All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Ethics Committee of Peking Union Medical College Hospital (approval No. I-24PJ0856). Written informed consent was obtained from the patients for the publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Surgical team

Both cases were carried out by a single surgeon and a single assistant. This surgical team had adequate experience of laparoscopic PN and had accomplished more than 800 da Vinci^® procedures as well as over 50 Shurui^® robotic surgeries (transperitoneal or retroperitoneal).

Procedure

After general anesthesia, the patient was placed in 60° lateral decubitus position. A 3 cm incision was made around the navel. Pneumoperitoneum was then established and a SP four-channel trocarintroduced. After docking, the 8 mm 3D high-resolution camera occupied the 6 o’clock channel; 6 mm robotic instruments (bipolar forceps, monopolar surgical scissors, and graspers) were placed at 3, 9, and 12 o’clock. A 12 mm assistant port was placed 8 cm superiorly to the robot port for suction and needle delivery.

Colon was flipped inward, and Gerota’s fascia was opened. After mobilization of renal artery, pararenal fat was removed to fully expose the tumor. Renal artery was then clamped with bulldog clamps. The tumor was resected. Subsequently, the scissors were replaced with a needle driver, and a double-layer, continuous barbed suture was used to repair the renal defect. Bulldog clamps were removed after proper hemostasis.

Postoperatively, both patients remained in bed for 48 hours, during which thrombo-embolic stockings were applied for deep vein thrombosis (DVT) prophylaxis. Intravenous prophylactic antibiotics were given for 24 hours. Analgesia was provided with intravenous non-steroidal anti-inflammatory drugs (NSAIDs) for the first 24 hours and oral NSAIDs as required. Pain intensity was assessed twice a day with the numeric rating scale (NRS): 0–3 mild, 4–6 moderate, and 7–10 severe. Perioperative data were recorded in Table 1.

Table 1. Perioperative data of the two cases.

Parameters	Case 1	Case 2
Age (years)	65	56
Gender	Female	Male
Detection to hospitalization time (days)	14	20
Symptom	None	None
Comorbidities and medications	Mild COPD, no treatment required	HBP, treated with oral antihypertensive drugs
Tumor
Tumor size (mm)	22	17
Tumor side	Right	Left
Tumor location	Mid-pole	Lower-pole
RENAL nephrometry score	5	6
TNM staging	T1N0M0	T1N0M0
Surgical related data
Docking time (min)	4	4
Console time (min)	112	135
WIT (min)	24	21
EBL (mL)	100	50
NRS on 24 hours (score/total)	2/10	2/10
NRS on day 2 (score/total)	0/10	1/10
Post-op hospitalization time (days)	5	6
Follow-up duration (months)	3	3
Pathology
Pathological type	Clear cell carcinoma	Clear cell carcinoma
Pathological grade	WHO grade 2	WHO grade 2
Surgical margin	Negative	Negative
Margin width (cm)	0.1	0.1
Laboratory test
Pre-op HGB (g/L)	145	139
Post-op HGB (g/L)	142	135
Pre-op Cr (μmol/L)	56	75
3 days post-op Cr (μmol/L)	55	78
3 months post-op Cr (μmol/L)	58	74

Normal range: HGB, 120–160 g/L; Cr, 59–104 μmol/L for male and 45–84 μmol/L for female. COPD, chronic obstructive pulmonary disease; Cr, creatine; EBL, estimated blood loss; HBP, high blood pressure; HGB, hemoglobin; NRS, numeric rating scale; post-op, post-operation; pre-op, pre-operation; RENAL, radius, exophytic, nearness, anterior/posterior, and location; TNM, tumor-node-metastasis; WHO, World Health Organization; WIT, warm ischemia time.

Case 1

A 65-year-old woman [body mass index (BMI), 23.03 kg/m²] was admitted with no discomfort after a 22 mm right mid-pole renal mass was detected on routine screening 2 weeks earlier. Past medical and family histories were unremarkable. Contrast-enhanced computed tomography (CT) revealed a heterogeneously hyper-enhancing lesion suspicious for malignancy [RENAL (radius, exophytic, nearness, anterior/posterior, and location) nephrometry score, 5]. On 13 August 2025, she underwent Shurui^® robotic-assisted SP laparoscopic PN. Docking time was 4 min, console time 112 min, and estimated blood loss (EBL) 100 mL. The operation proceeded smoothly, warm ischemia time (WIT) was 24 min, and the tumor was excised intact. Hemoglobin and creatinine values before and after surgery were both within normal limits. Pain scores (NRS) were 2/10 at 24 hours and 0/10 on post-operative day 2. The drain was removed on day 4, and the patient was discharged on day 5. Pathological report shows renal clear cell carcinoma [World Health Organization (WHO) grade 2], without involving the renal capsule, and no cancer is observed on the dissection surface. At the 3-month follow-up, the patient remained tumor-free with a well-healed, cosmetically satisfactory scar (Figure 2).

Figure 2.

Patient 1 with a 22 mm right mid-pole renal mass. (A) CT scan (the arrow indicates the location of the tumor). (B) Gross tumor specimen. (C) Postoperative wound. (D) Tumor resection. (E) Inner-layer renorrhaphy. (F) Outer-layer renorrhaphy. (G) Timeline for patient 1. CT, computed tomography.

Case 2

A 56-year-old man (BMI, 22.3 kg/m²) was admitted with no discomfort after an incidental 17 mm left lower-pole renal mass was found on routine ultrasound. Past medical and family histories were unremarkable. Contrast CT showed a 17 mm hyper-vascular lesion with rapid wash-out enhancement, highly suggestive of malignancy (RENAL nephrometry score, 6). On 19 August 2025, he underwent Shurui^® robotic-assisted SP laparoscopic PN. Docking time was 4 min, console time 135 min, and EBL 50 mL. Since the tumor was completely intrarenal, intraoperative ultrasound was used to delineate its margin. The procedure was completed uneventfully with a WIT of 21 min, and the tumor was removed en bloc. Pre- and postoperative hemoglobin and creatinine levels remained within the normal range. Pain scores (NRS) were 2/10 at 24 hours and 1/10 on post-operative day 2. The drain was removed on day 5, and the patient was discharged on day 6. Pathological report of renal clear cell carcinoma (WHO grade 2), adjacent to the capsule, with negative margins at the incision site. Three-month postoperative follow-up showed no evidence of tumor recurrence on CT scan, and the wound had healed excellently with good cosmetic appearance (Figure 3).

Figure 3.

Patient 2 with an incidental 17 mm left lower-pole renal mass. (A) CT scan (the arrow indicates the location of the tumor). (B) Gross tumor specimen. (C) Postoperative wound. (D) Tumor resection. (E) Inner-layer renorrhaphy. (F) Outer-layer renorrhaphy. (G) Timeline for patient 2. CT, computed tomography.

Discussion

To the best of our knowledge, this is the first report of transumbilical RAPN performed with the Shurui^® SP robotic system. Both procedures were completed without either instrument clashes, system failures, conversion to open, or standard multi-port robot. The perioperative metrics, console time (112 and 135 min), EBL (100 and 50 mL), WIT (24 and 21 min), and length of stay (5 and 6 days), were non-inferior to contemporary series using the da Vinci SP™ platform (9,10), and did not differ significantly from our conventional multi-port RAPNs (11,12). Recent publications comparing different robotic platforms in robot-assisted radical prostatectomy (RARP) have shown no significant differences in outcomes (13). More importantly, no Clavien-Dindo grade ≥ II complications occurred within 30 days, and surgical margins were negative in both patients.

Although oncological safety remains the primary endpoint, the putative advantages of SP surgery are reduced wound morbidity and improved cosmesis (14). Unlike previously published transperitoneal or retroperitoneal Shurui^® robotic-assisted SP laparoscopic PNs (6,15), we performed the procedure for the first time via a transumbilical approach, requiring only a 3 cm peri-umbilical incision placed within the natural skin crease of the patient’s navel. Postoperative pain scores (NRS) on the NRS were 2/10 at 24 hours and 0–1/10 by day 2; both individuals discontinued analgesia within 24 hours. These values are lower than the 3–4/10 typically observed after standard four-arm transperitoneal RAPN in published cohort (16), suggesting that smaller fascial trauma translates into measurable analgesic benefit. The midline umbilical scar heals imperceptibly, which was highly appreciated by both patients. One of whom specifically cited “invisible wound” as a decisive factor in choosing SP robotic over conventional multi-port robotic or laparoscopic surgery (17).

Several technical advantages deserve emphasis: (I) the Shurui^® 8 mm 3D camera provided 4K resolution equivalent to da Vinci SP (18); (II) the Shurui^® robot employs a dual-continuum, redundant NiTi-rod skeleton that enables 135° full-direction bending within an 8 mm single port, delivers >17 N payload capacity, and remains fully functional even if individual rods fracture (19); and (III) indocyanine-green firefly fluorescence is integrated into the console, facilitating real-time tumor demarcation and suture placement (20).

Limitations of this report include the small sample size, relatively low‑complexity tumors, lack of comparator, and limited follow-up data for renal function and oncologic control. Long-term oncological equivalence to established platforms will require prospective registry data. Nevertheless, the feasibility and safety profile demonstrated here provide the groundwork for such trials.

Conclusions

In conclusion, transumbilical SP-RAPN with the domestic Shurui^® robotic system is technically feasible and clinically effective. Wound morbidity, pain degree, and cosmetic outcomes appear non-inferior to conventional multi-port robotics, while short-term oncological and functional outcomes are acceptable. Larger comparative studies and long-term oncologic outcomes are warranted to validate these findings and to define the specific niches—cost containment, pediatric surgery, or hidden-scar oncological resection—where this new platform may offer the greatest benefit (21).

Supplementary

The article’s supplementary files as

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Ethics Committee of Peking Union Medical College Hospital (approval No. I-24PJ0856). Written informed consent was obtained from the patients for the publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.