Professor Sunghoo Hong of Seoul St. Mary’s Hospital Achieves Korea’s First Single-Port Robotic Surgery for Highly Complex Kidney Cancer

Stage 3 Kidney Cancer with Inferior Vena Cava Thrombus in an Elderly Patient

Seoul St. Mary’s Hospital, Catholic University of Korea, announced on the 16th that Professor Sunghoo Hong of the Department of Urology has successfully performed surgical treatment on an elderly patient with kidney cancer accompanied by inferior vena cava thrombosis using a single-port (SP, Single Port) robot. This is the first case in Korea and the second case in the world in which the most complex surgery—removing both the kidney cancer and the thrombus invading the inferior vena cava, the largest vein in the human body—was performed using a single-port robotic approach.

The patient who underwent the surgery is Mr. Heo, a male former educator in his 70s. Despite maintaining his health with regular exercise even after retirement, he experienced hematuria after an evening workout and visited a nearby clinic. An ultrasound examination indicated the need for care at a university hospital. Further tests revealed suspicion of right renal cancer, leading him to seek advanced care at Seoul St. Mary’s Hospital.

Professor Seonghoo Hong (right) from the Department of Urology at Seoul St. Mary's Hospital is taking a commemorative photo with an elderly patient (left) with stage 3 kidney cancer accompanied by inferior vena cava thrombosis, who visited the outpatient clinic for the first time after surgery using the retroperitoneal single-port robotic system for the first time in Korea. Seoul St. Mary's Hospital

Preoperative imaging revealed an 8 cm kidney tumor and a thrombus in the right renal vein. Due to a history of open abdominal surgery, he had extensive scarring across the abdomen, which suggested severe adhesions among the intra-abdominal organs, making surgery potentially difficult. Therefore, Professor Hong’s team planned to remove the right kidney using a single-port robotic surgery via a retroperitoneal approach, which does not traverse the peritoneum but rather accesses the area from the patient’s flank behind the peritoneum.

However, during the surgery on May 27, it was found that the renal vein thrombus had progressed and invaded the inferior vena cava. Professor Hong decided to remove both the tumor and the inferior vena cava thrombus simultaneously without making any additional incisions. After a two-hour and twenty-minute operation, the team successfully completed this highly complex surgery—which is challenging even by open surgery standards—using only a single incision, and the patient was discharged just four days after the procedure.

Venous tumor thrombus is a vascular complication commonly seen in kidney cancer patients, occurring in approximately 4–10% of all cases. The inferior vena cava is the largest vein in the body, returning deoxygenated blood from the lower half of the body to the heart. Because the surgery requires clamping or incising this large vessel and then restoring it, there is a risk of massive bleeding. If the thrombus dislodges during surgery, it can cause acute embolism in the lungs, brain, or major organs, potentially resulting in death on the operating table.

Kidney cancer accompanied by inferior vena cava thrombus is considered one of the most difficult and dangerous surgeries among urologic cancers. Nevertheless, such surgeries have continued to be attempted despite the risks, because if left untreated, the one-year survival rate drops below 30%, while complete removal of the tumor and thrombus can increase the five-year survival rate to over 50%. Traditionally, open surgery with extensive abdominal incisions has been the standard. Since the 2010s, advances in robotic techniques have made thrombectomy using multi-port robotic platforms possible, but the number of such procedures worldwide remains limited.

In particular, this case is significant because it used a retroperitoneal approach via single-port robotic surgery. Compared to transperitoneal approaches, the working space is extremely narrow and there are fewer anatomical landmarks, making the procedure more technically demanding. However, it offers advantages such as applicability to patients with intra-abdominal adhesions, faster recovery, and reduced pain, bleeding, and complications.

Professor Sunghoo Hong (right) from the Department of Urology at Seoul St. Mary's Hospital is taking a photo with an elderly patient (left) with stage 3 kidney cancer accompanied by inferior vena cava thrombosis, who visited the outpatient clinic for the first time after surgery using the retroperitoneal single-port robot, the first case in Korea. Photo by Seoul St. Mary's Hospital

On June 15, the patient visited the outpatient clinic for the first time after surgery and said, "I always exercised regularly and was confident about my health, but after being diagnosed with kidney cancer, I realized how silently this cancer can develop. I am deeply grateful to the medical staff for giving me a new lease on life—words cannot express my appreciation."

Professor Sunghoo Hong commented, "The significance of this surgery lies not only in removing the tumor thrombus with a single-port robot but also in proving that high-level vascular-invading kidney cancer surgeries can be performed via a retroperitoneal approach even in patients for whom transperitoneal access is difficult due to previous open abdominal surgeries. Although it was a difficult and risky operation, I feel greatly rewarded as a physician for completing it safely, and I will continue to pursue new treatment methods and surgical techniques to make patients' lives as comfortable as possible."

Professor Hong, who also serves as Director of the Robotic Surgery Center at Seoul St. Mary’s Hospital, achieved the milestone of 500 single-port urologic robotic surgeries as an individual—the first in the Asia-Pacific region in 2024. He has now performed 900 single-port urologic robotic surgeries and a total of 2,900 robotic surgeries, establishing himself as an authority in minimally invasive surgery for urologic oncology. In particular, he is actively performing partial nephrectomy using single-port robots in the field of kidney cancer, achieving excellent outcomes by effectively removing tumors while maximizing kidney function and reducing the risk of dialysis after surgery.

In 2016, he also became the first in Korea to successfully perform minimally invasive surgery using laparoscopy and robotics, instead of open surgery, for a kidney cancer patient with inferior vena cava thrombus. His achievements extend beyond Korean patients; in 2023, he successfully treated a Vietnamese patient who traveled to Korea seeking his expertise, performing multi-port robotic surgery for kidney cancer with inferior vena cava thrombus. He has thus pioneered the field of complex robotic kidney cancer surgery.

Meanwhile, this year, Seoul St. Mary’s Hospital performed its 20,000th robotic surgery, demonstrating its status as a leading K-medical hospital in minimally invasive treatments not only in Korea but internationally. In particular, the Department of Urology surpassed 7,000 urologic robotic surgeries in January this year, establishing itself as having the highest level of robotic surgery capabilities in a single department nationwide. The hospital is actively expanding the scope of both traditional robotic surgeries and the latest single-port robotic procedures, like this case, gradually broadening their application to more complex surgeries.

This content was produced with the assistance of AI translation services.