Robot-Assisted Partial Nephrectomy for Multiple Allograft Renal Cell Carcinomas: A Case Report

•RAPN is effective in multiple allograft RCCs.•RAPN helps ensure renal function preservation postop.•RAPN has minimal postoperative complications.•RAPN has significant utility in complex allograft cases.•Our findings advance minimally invasive approaches in transplants. Partial nephrectomy (PN) is strongly recommended as nephron-sparing surgery for T1 renal tumors. Although there have been some reports of robot-assisted PN (RAPN) for solitary allograft renal tumors, only a few cases of RAPN for multifocal allograft renal tumors have been reported. Herein, we report a case of a patient who underwent RAPN for multifocal allograft renal cell carcinoma (RCCs). A 77-year-old male was diagnosed with 24- and 15-mm lesions in the middle portion of a right iliac fossa renal allograft. RAPN was performed using a transperitoneal approach 22 years after the kidney transplantation. The allograft renal artery was clamped, and the tumors were resected. Pathological examination revealed clear-cell RCC with negative surgical margins. There were no perioperative complications, and kidney function did not significantly change during surgery. RAPN is a feasible and effective treatment option for multiple allograft RCCs. The successful preservation of renal function coupled with minimal perioperative complications underscores the potential of RAPN. Our observations suggest that RAPN can be safely implemented in similar high-risk cases, offering a nephron-sparing alternative that might extend quality of life and reduce the need for dialysis in transplant recipients.