<p>Radical nephroureterectomy is the standard treatment for renal upper urinary tract urothelial cancer, but may expose patients to renal failure and hemodialysis. We aimed to evaluate the outcomes of nephron-sparring surgery in three selected cases of localized renal UUTUC confined to a single calyx treated by segmental 3D image-guided robot assisted partial nephrectomy. All tumors were non-invasive and confined to either the superior or inferior calyx, refractory to endoscopic treatment and without evidence of synchronous lesions, lymph nodes involvement, or metastasis. All procedures were performed using the Da Vinci Xi robot, with preoperative planning and intraoperative guidance based on a 3D-model reconstructed from CT-urography. Key surgical principles included selective devascularization, avoidance of main artery clamping, and no opening of the concerned excretory tract. Mean patient age was 58 years, estimated blood loss was 166 mL and mean operative time was 272&#xa0;min. All patients were discharged on postoperative day 1, with no perioperative complications. On patient experienced recurrences treated successfully by ureteroscopy. At 23,3 months of median follow-up, all patients were disease-free. Although limited to three patients, this initial experience suggests the potential value of this technique performed in specific settings. However, larger studies with long-term follow-up are warranted to confirm its feasibility and potential for renal preservation.</p>