Abstract
BACKGROUND: Robot-assisted radical prostatectomy in kidney transplant recipients presents unique technical challenges owing to anatomical alterations. However, Hugo™ robotic-assisted surgery system, with its independently mounted robotic arms, may offer advantages in such complex cases. Herein, we report the first case of robot-assisted radical prostatectomy using a Hugo robotic-assisted surgery system in a post-kidney transplant patient. CASE PRESENTATION: A 55-year-old Japanese male with a history of ABO-incompatible living donor kidney transplantation was diagnosed with high-risk prostate cancer (cT2bN0M0, Gleason score 4 + 4 = 8) at 1-year post-transplant. Robot-assisted radical prostatectomy was performed using a Hugo robotic-assisted surgery system. Despite encountering dense adhesions that led to inadvertent cystotomy during prevesical dissection, the procedure was completed within 336 minutes and with blood loss of 50 mL. Postoperative course was uneventful, with stable renal function, and pathological examination revealed a pT2bN0M0 adenocarcinoma with negative surgical margins. CONCLUSION: This case demonstrates the technical feasibility of Hugo robotic-assisted surgery system for radical prostatectomy in kidney transplant recipients. This offers practical insights into overcoming anatomical challenges post-transplantation, and may inform broader applications of complex pelvic procedures in this population.