Category: Laparoscopic/ Robotic: Renal

VS7-11 - Robotic assisted partial nephrectomy in a morbid obese patient with a horseshoe kidney

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : Horseshoe kidney is a congenital anomaly characterize by the fusion of both kidneys. Horseshoe kidney usually has abnormal vascularity. These anatomical variants offered a challenge in the minimally invasive treatment of renal tumors. Also, morbid obesity represent an adititonal challenge based on the management of the perirenal fat inflammation. 
We present our technique for robotic assisted partial nephrectomy in a horseshoe kidney in this population.

Methods : A 68 y/o male underwent work up for gross hematuria in another institution. Abdomem pelvic CT scan showed a 2.5 cm left posterior upper pole mass on a previosuly undiagnosed horseshoe kidney. Work up incuded a CT angiogram to evaluate vasculature. Nephrometry score was 1+2+2+p+1: 5p. CT angiogram showed that  left moiety had a single renal artery and renal vein. Patient opted for robotic assisted partial nephrectomy. Fourth arm was used to create space and improve hilar dissection in morbid obese patient. Also, fourth arm was used to fold the kidney and evaluate exposure of the mass. Renal artery was clamped previous to resection. Fouth arm was used to improve exposure during resection of the tumor.

Results : Console time was 218 minutes with estimate blood loss of 50 ml. Warm ischemia time was 12 minutes. Patient was discharged home next dauy. There were no perioperative complications. Pathology revelaed a 2.5 cm. oncocytoma.

Conclusions : We present some technical points to show that robotic assisted partial nephrectomy in a horseshoe kidney is feasible in a morbidly obese patient with posterior renal tumors.

Braulio Cuesta-Camunas

Medical student
University of Puerto Rico
Bayamon, Not Applicable, Puerto Rico

Ronald G. Cadillo-Chavez

Assistant professor
University of Puerto Rico
Guaynabo, Not Applicable, Puerto Rico

Ronald Cadillo-Chavez MD
Assistant Profesor University of Puerto Rico
Robotic Urology & Oncology Institute
Robotic Urologic Oncology and Reconstructive Surgery.