Category: Robotic Surgery: Upper Tract - Benign
Introduction & Objective : Horseshoe kidneys are associated with an increased rate of other urologic abnormalities including ureteropelvic junction obstruction, vesicoureteral reflux, and vascular anomalies. Abnormal angulation of the proximal ureter can make endoscopic management of renal obstruction difficult. In this video we demonstrate a robotic dismembered pyeloplasty on an obstructed horseshoe kidney.
Methods : An otherwise healthy 47 year old man had symptomatic return of left ureteropelvic junction obstruction after a laparoscopic pyeloplasty. He presented with flank pain and imaging demonstrating obstruction. After discussion of the options, the patient elected to undergo a re-do pyeloplasty.
Results : The patient underwent a robotic-assisted dismembered pyeloplasty using the daVinci Xi robotic system. An anomalous crossing vessel was encountered and divided. The capacious renal pelvis was tailored and the ureter re-anastomosed to the most dependent portion of the renal pelvis.
Conclusions : The functional and structural abnormalities associated with horseshoe kidneys can be a challenge. The daVinci robotic system allows for excellent visualization and manipulation of aberrant anatomy, allowing for successful reconstruction and relief of obstruction.
Jacob McCoy– Urology Resident, Ochsner Clinic Foundation, New Orleans, Louisiana
Stephen Carriere– Urology Resident, Ochsner Clinic Foundation, Jefferson, Louisiana
Michael Maddox– Staff Urologist, Ochsner Clinic Foundation, New Orleans, Louisiana