{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:50:29Z","timestamp":1791453029081,"version":"4.3.3"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272840"],"award-info":[{"award-number":["82272840"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2021A1515010129"],"award-info":[{"award-number":["2021A1515010129"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2023A1515012925"],"award-info":[{"award-number":["2023A1515012925"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Our objective was to evaluate the safety and efficacy of staged, anatomy\u2010tailored robot\u2010assisted left renal vein (LRV) transposition procedures for the treatment of nutcracker syndrome (NCS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective single\u2010centre study (2019\u20132025) included 88 patients stratified by technique: conventional (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200927), robotic side\u2010clamp two\u2010step (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921), LRV\u2010proximal left gonadal vein (LGV) transposition (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920), and LRV\u2010distal LGV transposition (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920). The primary outcome was the renocaval pressure gradient (RPG), with secondary outcomes including operative metrics, symptom resolution, and complications. Median follow\u2010up was 12\u2009months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Robot\u2010assisted LRV\u2010distal LGV transposition groups demonstrated superior perioperative outcomes to conventional surgery: operative time (median 200 vs 344\u2009min;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), blood loss (36.5 vs 66.0\u2009mL;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and hospital stay (4.5 vs 8.0\u2009days;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Postoperative RPG was \u22643\u2009mmHg in all patients. The LRV\u2013proximal LGV transposition yielded the greatest RPG reduction (\u03942.8\u2009mmHg) and lowest postoperative RPG (1.5\u2009mmHg). Complete resolution of varicocele and pelvic\/scrotal pain was achieved in all eligible patients undergoing the LRV\u2013distal LGV transposition. Pain scores were low across all groups (mean pain score: 1.7).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The staged technical evolution in robotic LRV transposition, from the side clamp two\u2010step technique to anatomy\u2010tailored LRV\u2013LGV transposition, demonstrated favourable renocaval pressure gradient normalization, symptom relief, and perioperative outcomes. Based on our single\u2010centre experience, we propose a preliminary anatomy\u2010tailored treatment algorithm: the side clamp two\u2010step technique for uncomplicated cases, LRV\u2010proximal LGV transposition for proximal LGV dilation (\u22655\u2009mm), and LRV\u2010distal LGV transposition for patients with varicocele or pelvic congestion. This framework serves as an institutional reference that warrants further multicentre validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70482","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:02:56Z","timestamp":1791450176000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic left renal vein transposition for nutcracker syndrome: side\u2010clamp to tailored reconstruction"],"prefix":"10.1111","author":[{"given":"Jinbin","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital Sun Yat\u2010sen University  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zifeng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital Sun Yat\u2010sen University  Guangzhou Guangdong 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Affiliated Hospital Sun Yat\u2010sen University  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuedian","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital Sun Yat\u2010sen University  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3009-439X","authenticated-orcid":false,"given":"Weihao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital Sun Yat\u2010sen University  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoming","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology, The Third Affiliated Hospital Sun Yat\u2010sen University  Guangzhou Guangdong 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