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Robot-assisted retrograde intrarenal surgery for residual superior calyceal stone after multiple endourological interventions: a case report

Year: 2026

Type: article

Abstract: Introduction and importance: Residual renal stones after multiple endourological procedures can be difficult to manage, particularly in the superior calyx. Robot-assisted retrograde intrarenal surgery (RIRS) has emerged as a potential alternative to improve surgical precision and intrarenal navigation in complex cases. Case presentation: A 55-year-old woman with recurrent nephrolithiasis underwent multiple prior procedures, including ureteroscopy and percutaneous nephrolithotomy (PCNL). Follow-up imaging revealed a residual 7 × 8 mm stone in the left superior calyx. Due to the challenging anatomy after repeated interventions, robot-assisted RIRS using the Zamenix P Platform was performed. The stone was fragmented using a thulium fiber laser and successfully extracted, achieving complete stone clearance without perioperative complications. The patient was discharged on the second postoperative day and remained symptom-free at one-month follow-up. Clinical discussion: Residual superior calyceal stones are technically challenging because of difficult angulation and altered intrarenal anatomy after repeated procedures. In this case, robot-assisted RIRS provided stable intrarenal access and controlled laser targeting without excessive scope manipulation. Although robotic systems offer ergonomic and technical advantages, cost, operating room setup, and training requirements remain important considerations. Conclusion: Robot-assisted RIRS was feasible and safe for treating a residual superior calyceal stone after multiple prior endourological interventions. In selected patients with complex residual renal stones and altered intrarenal anatomy, robot-assisted RIRS may facilitate precise intrarenal navigation and complete stone clearance. Careful patient selection remains essential, and larger clinical studies are needed to further define its role in contemporary stone management.

Source: International Journal of Surgery Case Reports

DOI: 10.1097/rc9.0000000000000954

Authors: Aditya Wicaksono, Dyandra Parikesit, Widi Atmoko, Gerhard Reinaldi Situmorang, Ponco Birowo, Sung Yong Cho

Institutions: University of Indonesia, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Seoul National University, Seoul National University Hospital

Language: English

Topic: Kidney Stones and Urolithiasis Treatments

Subfield: Urology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090