Mediathek

Abstract

J.-U. Stolzenburg¹, M. Do¹, A. Dietel¹, I. Kyriazis*¹, R. Ganzer¹

¹Universitätsklinikum Leipzig, Leipzig, Deutschland

Introduction: Partial nephrectomy in a horseshoe kidney renal mass is an uncommon surgical procedure challenged by thealtered renal anatomy of this congenital defect. In this video we present our robotic assisted technique in this rare entity.

Materials and methods: We document our technique in a case of a large upper pole renal mass at the right side of ahorseshoe kidney.

Results: Due to the presence of several accessory arteries in the case of horseshoe kidney, the full vasculature in theipsilateral side has to be exposed. In addition, the contralateral renal artery should also be exposed prior to tumor excision, as apreparation for the case of an emergency conversion to ipsilateral side nehrectomy that will require horseshoe ithmus division.The upper pole renal arteries are being clipped and dissected and the lower pole arteries are being clamped. A conventionaltumor excision and renorrhaphy is then performed under warm ischemia followed by early unclamping of the lower pole arterialbranches. Proper hemostasis is verified and ensured by applying hemostatic agents over tumor bed.

Conclusions: Robotic-assisted partial nephrectomy in cases of horseshoe kidney tumors is feasible. A meticulous anatomicdissection of all accessory arterial branches is necessary to ensure the safety of the approach and the optimum functionaloutcome for the remaining parenchyma.