Laparoscopic retroperitoneal partial nephretectomy with Selective DVD clamping in horseshoe kidney
Laparoscopic retroperitoneal partial nephrectomy with selective clamping in horseshoe kidney
Z. Kiss1, M. Murányi1, T. Flaskó1
1University of Debrecen, Department of Urology, Debrecen, Ungarn
Introduction & Objectives: Horseshoe kidney is one of the most common renal fusion anomaly. The incidence is 0,25 % among general population. Renal cell carcinoma is the most common tumor associated with horseshoe kidney. There are only few reports of laparoscopic surgery in horseshoe kidney. The authors present a laparoscopic retroperitoneal partial nephrectomy with selective clamping for renal cell carcinoma in horseshoe kidney.
Material and methods: A 60-year-old man was referred to our department presenting with a 2 cm renal mass in a horseshoe kidney on the left side, which was found incidentally on ultrasound during the evaluation of dermatological symptoms. Abdominal computed tomography (CT) was performed, which revealed a 2 cm mass on the upper pole of the left moiety posteriorly. Laparoscopic partial nephrectomy was performed with selective clamping. Due to tumor location retroperitoneal approach was applied.
Results: The operating time was 115 minutes, the warm ischaemia time was 20 minutes and the estimated blood loss was 50 ml. The postoperative period was uneventful and the hospital stay was 3 days. The histopathological examination revealed pT1a, renal cell carcinoma with negative surgical margin. After 6 months abdominal CT was performed, which revealed no local recurrence.
Conclusions: Horseshoe kidney is a well-known congenital anomaly. Laparoscopic surgery of horseshoe kidney can be challenging, because of the comlex vasculature and the presence of isthmus. The unique anatomical structure can limit the mobilization of kidney, therefore different approach is recommended depending on the tumor location. Accurate knowledge of the number and location of the vessels is also crucial before the operation.