Seoul St. Mary's Hospital surgeon becomes first in Asia-Pacific to perform 1,000 single-port robotic urologic surgeries

Prof. Hong Sung-hoo of the urology department at Catholic University of Korea Seoul St. Mary's Hospital became the first surgeon in the Asia-Pacific region to perform 1,000 single-port robotic urologic surgeries, reaching the milestone Monday.

Surgeons outside the United States who have surpassed 1,000 individual procedures using the da Vinci SP robot are rare, the hospital said Tuesday. Hong also adopted an unusual training regimen in the early days of robotic surgery: repeatedly folding paper cranes the size of a thumbnail using the robotic system to sharpen his precision.

Urologic cancer patients accounted for 97 percent of all procedures. By disease type, kidney cancer was the most common at 54 percent, followed by prostate cancer at 30 percent, ureteral cancer at 14 percent and bladder cancer at 2 percent.

Kidney cancer is often called a "silent cancer" because it produces almost no symptoms in its early stages. The number of patients diagnosed in South Korea more than doubled from 22,279 in 2014 to 45,678 in 2024. Because radiation and chemotherapy offer limited effectiveness against the disease, surgical removal of the tumor is considered the most effective treatment.

Single-port partial nephrectomy — a procedure that removes only the cancerous portion of the kidney to preserve organ function — accounted for 539 cases, or 54 percent of all surgeries. The 1,000th patient, a woman in her 60s with kidney cancer, underwent the procedure, allowing surgeons to remove the tumor while preserving as much kidney function as possible.

Because the kidneys filter blood and receive a high volume of blood flow, surgeons temporarily cut off circulation to the organ during kidney cancer operations to minimize bleeding while excising the tumor.

The length of time blood flow is blocked — known as warm ischemia time — is a critical surgical indicator, as longer interruptions can hinder post-operative kidney function recovery. How quickly and accurately the tumor is removed is therefore a key measure of surgical performance.

Single-port robotic surgery has long been seen as a trade-off: fewer incisions mean less scarring and pain, but maneuvering multiple instruments through a single access point was thought to make the procedure slower than multi-port surgery, which uses several incisions.

However, a retrospective comparison by Hong's research team of single-port and multi-port robotic surgery outcomes in kidney cancer patients found that the average warm ischemia time for single-port procedures was 13.8 minutes — 3.4 minutes shorter than the 17.2-minute average for multi-port surgery.

Total operating time also favored the single-port approach, averaging 95.4 minutes compared with 103.7 minutes for multi-port procedures. Single-port surgery produced results equal to or better than multi-port surgery across other indicators as well, including blood loss and length of hospital stay, the hospital said.

The study was published in the Journal of Endourology in December 2024 and received an academic award in the international submission category at the 31st annual conference of the Korean Endourological Society.

Hong, who serves as director of the robotic surgery center at Seoul St. Mary's Hospital, applies single-port robotic techniques to a wide range of complex urologic cancer procedures.

He was the first in South Korea to perform a Retzius-sparing prostatectomy — a technique that preserves structures surrounding the prostate — using single-port robotic surgery, reducing post-operative complications such as urinary incontinence and erectile dysfunction. In kidney cancer, he has also demonstrated the effectiveness of a retroperitoneal single-port partial nephrectomy approach, which lowers the risk of damage to abdominal organs.

More recently, he became the first surgeon in South Korea and only the second in the world to treat an elderly kidney cancer patient with inferior vena cava thrombus using single-port robotic surgery.

Hong also collaborates with overseas medical professionals on education and joint research. In late 2024, he and visiting Middle Eastern physicians training at Seoul St. Mary's Hospital published a new surgical technique applying the da Vinci SP robot to nutcracker syndrome in an international academic journal.

"I believe it is a physician's duty to give courage and hope to patients who have fallen into despair," Hong said. "I will continue to do my best to develop better treatments through research on malignant diseases including kidney and prostate cancer, and to bring those advances into clinical practice."