Seoul St. Mary\'s Hospital, Prof. Sung-Hoo Hong Performs Korea’s First Highly Complex Single-Port Robotic Surgery for Kidney Cancer

Prof. Sung-Hoo Hong Performs Korea’s First Highly Complex Single-Port Robotic Surgery for Kidney Cancer
 

Elderly Patient with Stage 3 Kidney Cancer and Inferior Vena Cava Thrombus Recovers After Retroperitoneal Single-Port Robotic Surgery


 

Photo: Prof. Sung-Hoo Hong of the Department of Urology at Seoul St. Mary’s Hospital poses for a commemorative photo with the patient during the first outpatient visit after surgery.

Korea’s First and the World’s Second Retroperitoneal Single-Port Robotic Surgery

Professor Sung-Hoo Hong of the Department of Urology at Seoul St. Mary’s Hospital successfully treated an elderly patient with kidney cancer accompanied by an inferior vena cava (IVC) thrombus using a single-port (SP) robotic system.

The procedure required removal of both the kidney tumor and the thrombus extending into the inferior vena cava, the body's largest vein. It marks the first case in Korea and the second in the world in which this highly complex surgery was performed using a retroperitoneal single-port robotic approach.

A New Surgical Option for Patients with Intra-abdominal Adhesions

The patient, a man in his 70s, was referred to Seoul St. Mary's Hospital after developing hematuria and being diagnosed with suspected right kidney cancer. Preoperative imaging revealed an 8 cm kidney tumor and a thrombus in the right renal vein. Because he had previously undergone open abdominal surgery, severe intra-abdominal adhesions were expected.

Professor Hong's team therefore selected a retroperitoneal single-port robotic approach, accessing the kidney through the space behind the peritoneum without entering the abdominal cavity.

During surgery, the team found that the thrombus had extended into the inferior vena cava. Without making any additional incision, Professor Hong successfully removed both the tumor and the thrombus through a single incision in a 2-hour and 20-minute operation. The patient was discharged four days after surgery.

Expanding Minimally Invasive Treatment for Complex Kidney Cancer

Kidney cancer with an inferior vena cava thrombus is considered one of the most challenging urologic cancers because the procedure requires clamping, opening, and reconstructing a major blood vessel, with risks including massive bleeding and acute embolism. Open surgery has traditionally been the standard treatment, while robotic thrombectomy using multi-port systems has only been attempted in limited cases worldwide.

This case is particularly significant because it demonstrates that a retroperitoneal single-port robotic approach can be used even for highly complex kidney cancer surgery. Although the retroperitoneal approach provides a limited working space and requires advanced surgical expertise, it may also benefit patients with intra-abdominal adhesions while allowing faster recovery, less pain, reduced bleeding, and fewer complications.

"A New Life" for the Patient

At his first outpatient visit after surgery, the patient said, "I had always exercised regularly and thought I was healthy, but after being diagnosed with kidney cancer, I realized how silently the disease can develop. I am deeply grateful to the medical team who gave me a new life."

Professor Hong commented, "The significance of this surgery lies in proving that even patients with previous open abdominal surgery, for whom a transperitoneal approach is difficult, can undergo highly complex kidney cancer surgery involving major vascular invasion through a retroperitoneal approach."

He added, "We will continue to develop new surgical techniques and treatment strategies that help improve patients' quality of life."

Leading Innovation in Robotic Kidney Cancer Surgery

Professor Hong, Director of the Robotic Surgery Center at Seoul St. Mary's Hospital, became the first surgeon in the Asia-Pacific region to perform 500 single-port robotic urologic surgeries in 2024. He has now completed 900 single-port robotic urologic procedures and 2,900 robotic surgeries overall.

He also performed Korea's first minimally invasive laparoscopic and robotic surgery for kidney cancer with an inferior vena cava thrombus in 2016 and successfully treated a Vietnamese patient with the same condition using multi-port robotic surgery in 2023.

Meanwhile, Seoul St. Mary's Hospital surpassed 20,000 robotic surgeries this year, while its Department of Urology exceeded 7,000 robotic urologic surgeries in January 2026, continuing to expand the application of robotic surgery for highly complex procedures.