V1716 ROBOTIC PARTIAL NEPHRECTOMY AND PYELOLITHOTOMY IN A HORSESHOE KIDNEY

Abstract

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2012V1716 ROBOTIC PARTIAL NEPHRECTOMY AND PYELOLITHOTOMY IN A HORSESHOE KIDNEY Wesley White, Adam Stewart, W. Bedford Waters, and Frederick Klein Wesley WhiteWesley White Knoxville, TN , Adam StewartAdam Stewart Knoxville, TN , W. Bedford WatersW. Bedford Waters Knoxville, TN , and Frederick KleinFrederick Klein Knoxville, TN View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1675AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Horseshoe kidney represents the most common of all renal fusion anomalies with a reported incidence of 1 in 400. Myriad configurations of horseshoe kidney have been reported with the degree of ascent limited by the Inferior Mesenteric Artery (IMA). The majority of horseshoe kidneys demonstrate anteriorly oriented renal pelves and ureters and a highly variable and complex blood supply. Patients with horseshoe kidney are at a comparably higher risk of stone formation given their anomalous anatomy. In addition, renal tumors have been reported in patients with horseshoe kidneys but at a rate comparable to the general population. We present our experience with robotic partial nephrectomy and concomitant pyelolithtotomy in a horseshoe kidney. METHODS A 54 year old male presented with radiographic evidence of an approximate 7cm complex cystic renal mass involving the leftward moiety of his horseshoe kidney. In addition, an approximate 4cm partial staghorn calculus was identified involving his left renal pelvis. Following informed consent, the patient was positioned in the flank position and ports were placed in a somewhat more caudad location. The colon was reflected and the aorta identified. The anomalous arterial branches were identified and dissected out in preparation for hilar clamping. The tumor was exposed and intraoperative ultrasound performed. The tumor was excised with a margin of normal renal parenchyma. Reconstruction was performed using 2-0 Vicryl and 0-Vicryl sutures for the parenchyma and capsule, respectively. Next, the left ureter was identified and followed cephalad towards the renal pelvis. The renal pelvis was opened, the stone extracted, and the pyelotomy closed using running 4-0 Vicryl suture. RESULTS Operative time was 160 minutes. Estimated blood loss was 100cc. Warm ischemia time was 22 minutes. There were no acute intraoperative complications. The patient did develop a DVT postoperatively and was treated accordingly. Pathology demonstrated a pT1b renal cell cancer with negative margins as well as a 4cm x 2.5cm calcium oxalate stone. CONCLUSIONS Based on our experience, robotic partial nephrectomy in a horseshoe kidney is feasible and safe. Meticulous attention to the patient's arterial anatomy is paramount to avoid hemorrhagic complications. An individualized approach to port placement is necessary to avoid instrument clashing and to facilitate optimal access to the kidney. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited by Ng A, Nathan A, Campain N, Fortune-Ely M, Patki S, Yuminaga Y, Mumtaz F, Gulamhusein A, Tran M, Nathan S, Barod R, Bex A and Patki P (2022) Robot-assisted surgery in horseshoe kidneys: A safety and feasibility multi-centre case seriesJournal of Clinical Urology, 10.1177/20514158221088451, VOL. 17, NO. 4, (355-362), Online publication date: 1-Jul-2024. Raison N, Doeuk N, Malthouse T, Kasivisvanathan V, Lam W and Challacombe B (2018) Challenging Situations in Robotic Partial Nephrectomy The Management of Small Renal Masses, 10.1007/978-3-319-65657-1_14, (153-161), . Volume 187Issue 4SApril 2012Page: e692 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research