Robot-assisted retrograde intrarenal surgery for residual superior calyceal stone after multiple endourological interventions: a case report
- 1Department of Urology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- 2Urology Medical Staff Group, Universitas Indonesia Hospital, Universitas Indonesia, Depok, Indonesia
- 3Department of Urology, Seoul National University Hospital, Seoul, Korea
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.
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BibTeX
@article{wicaksono2026robotassisted,
title = {{Robot-assisted retrograde intrarenal surgery for residual superior calyceal stone after multiple endourological interventions: a case report}},
author = {Aditya Wicaksono and Dyandra Parikesit and Widi Atmoko and Gerhard Reinaldi Situmorang and Ponco Birowo and Sung Yong Cho},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = oct,
doi = {10.1097/rc9.0000000000000954},
url = {https://doi.org/10.1097/rc9.0000000000000954},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Robot-assisted retrograde intrarenal surgery for residual superior calyceal stone after multiple endourological interventions: a case report
AU - Aditya Wicaksono
AU - Dyandra Parikesit
AU - Widi Atmoko
AU - Gerhard Reinaldi Situmorang
AU - Ponco Birowo
AU - Sung Yong Cho
PY - 2026
DA - 2026/10/01
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000000954
UR - https://doi.org/10.1097/rc9.0000000000000954
AB - 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.
SN - 2210-2612
ER -