Category: Laparoscopic/ Robotic: Renal

VS14-13 - Double Retroaortic Renal Vein. Complex laparoscopic radical nephrectomy

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

The embryogenesis of the inferior vena cava is a complex process involving the formation of several anastomoses between three paired embryonic veins that results in anatomical variations.

The anatomy of the renal veins is variable. The retro-aortic left renal vein (RLRV) passes posterior to the aorta. The incidence of RLRV is reported between 0.6-3.7%. Double RLRV is much rarer.

RLRV are classified in two main types, according to the obliteration type of embryonic renal venous collar: Type I results from the persistence of the left sub-supracardinal anastomosis, the intersupracardinal anastomosis, and the left dorsal renal vein. Type II develops by the persistence of the left subsupracardinal anastomosis and the supracardinal vein.

RLRV present surgical difficulties during left laparoscopic nephrectomy in both transperitoneal and retroperitoneal approaches.

In the present video we present the case of laparoscopic radical nephrectomy in a patient with double retro-aortic left renal vein. 

Methods :

Clinical case: 70 year-old male with the incidental diagnosis of left upper pole tumor (4x3 cm) involving the renal sinus. Contrast enhanced CT scan showed the presence of a complex left vascularization including double retro-aortic left renal veins and double left renal arteries with multiple branches.

Indication for left radical nephrectomy was established.

Surgical strategy was modified to assure safety:

-Wide colon mobilization

- Division of the ureter and gonadal vein and posterolateral attachments of the lower pole to gain posterior access to the renal pedicles (behind the venous plane)

Results :

Radical nephrectomy was performed without complications.

OR time was 105 minutes and EBL

Postoperative course was uneventful. Hospital stay was 72 hours.

Conclusions :

Double RLRV is a very rare anatomical variation of the left renal vein that poses major technical challenges for surgery. Adequate recognition of the anatomy in cross-sectional radiologic tests helps to adapt the surgical strategy to perform radical nephrectomy without complications.

Jorge Turo-Antona

University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

Jorge Turo Antona
Especialista en Urología
Facultativo Especialista en el Servicio de Urología del Hospital Universitario Puerta de Hierro de Majadahonda (Madrid)

Juan Martín de Pedro

Hospital Español de Buenos Aires
Buenos Aires, Buenos Aires, Argentina

Martin Parini

Hospital Español de Buenos Aires
Buenos Aires, Buenos Aires, Argentina

Gema Del Pozo Jiménez

Staff Urologist
University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

- 2003-2009: Doctor of Medicine and Surgery (MD). University of Alcalá, Madrid, with a final grade of Honours.
- 2010-2015: Urology Residency. General University Hospital Gregorio Marañón, Madrid.
- 2013-2017: Degree in Design and Statistics in Health Sciences. Autonoma University of Barcelona.
- November, 2014: European Board of Urology (EBU) Online Written Examination. Madrid.
- June, 2015: European Board of Urology (EBU) Oral Examination. Brussels.
- 2013-2017: PhD. Complutense University of Madrid with mention of "Cum laude" with the title: Predictive model of mortality in patients with transitional bladder cancer treated with radical cystectomy.
- October 2017: Enrollment in the Master in Health Research Methodology. Autonoma University of Barcelona.
- January-May 2018: University Title of Expert in Urooncology of the Autonoma University of Madrid,
- Currently working as FEA of Urology since June 2015 in Puerta de Hierro University Hospital (Majadahonda), as well as a private activity in H.U. La Zarzuela and H. University H.M. Torrelodones.
• Practical teaching in the subject of Urology of the Autonoma University of Madrid in H.U.Puerta de Hierro (2015-2018).
• Online teaching as a professor in the course of laparoscopic and robotic radical cystectomy (1st Edition) of the European School of Urological Laparoscopy (2018).
3.-PUBLICATIONS IN JOURNALS: Five publications as author, four publications as co-author (three in Spanish Archives of Urology and one chapter of the Urology Resident's Book (Internet)) and four abstracts of European and world congresses, three as author and one as co-author (European Urology Supplements and Journal of Endourology).
4- COMMUNICATIONS PRESENTED AT NATIONAL CONGRESS: As author 32 papers: Eighteen papers and as co-author 36 co-author papers.
5- SUBMITTED VIDEOS IN CONGRESS: 14 videos as author and 6 videos as co-author.
6-COMMUNICATIONS/VIDEOS PRESENTED AT INTERNATIONAL CONGRESS: As author (9 presentations) and as co-author (4 presentations).

Juan Hermida

Chairman. Urology Department
HU Madrid Torrelodones
Torrelodones, Madrid, Spain

Ignacio T. Castillón Vela

Staff urologist
H.U. Puerta de Hierro. Majadahonda
Villaviciosa de Odón, Madrid, Spain

Consultant Urologist. Department of Urology.
Hospital Universitario Puerta de Hierro Majadahonda
H.U. Madrid Torrelodones.
Escuela Europea de Laparoscopia Urológica. Madrid

1984-1990 Doctor of Medicine. Universidad Autónoma de Madrid
1992-1997 Urology Residency. Department of Urology. Fundación Jiménez Díaz. Madrid.
1998. Certificate. Educational Comission for Foreign Medical Graduates (ECFMG).
2/1999- 1/2001 Clinical Fellow in Kidney and Pancreas Tansplantation
National Institute of Transplantation - St Vincent Medical Center. Departament of Urology. University of Southern California (USC). Los Ángeles, California. EEUU.
2001 PhD in Medicine and Surgery. Universidad Autónoma de Madrid.
2005-2006 Master in Medical Direction and Clinical Management Universidad Nacional de Educación a Distancia (UNED)
2008 University Expert Certificate in “E learning 2.0: Internet Education and On line training". Universidad Nacional de Educación a Distancia (UNED)
2009 Accreditation as Da Vinci Robot Console Surgeon.

Editor of 4 Books
Author in 5 chapters in urological Books
Editor/Author of 9 Audiovisual Projects
27 Articles in indexed Journals
85 Panel Presentations in Urological Meetings
114 Podium/Poster/Video presentations at urological meetings.

Reviewer for the following Journals:
- Archivos Españoles de Urología
- Urology
- Journal of Endourology
Reviewer for the selection commitee:
- Spanish AEU Annual Meeting
- European Association of Urology (EAU) Annual Meeting