Category: Laparoscopy: Lower Tract - Benign

VS12-9 - Laparoscopic radical nephrectomy for pelvic ectopic nonfunctional kidney with malrotation of vasculature and ureteropelvic junction obstruction

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Ectopic pelvic kidney is rare developmental anomaly with potential cause of abnormal blood supply and UPJ obstruction, which may cause difficulty for minimally invasive surgery. Laparoscopic radical nephrectomy for pelvic kidney is an operation with few precedent, for which may offers the advantages of the minimally invasive approach. We will present our experience in the literature for laparoscopic nephrectomy in a 19-year-old male with symptomatic ectopic nonfunctioning pelvic kidney.


Methods : A 19-year-old male without systemic disease suffered from severe low abdominal pain and was diagnosed by contrast CT as left ectopic kidney in pelvis with severe hydronephrosis suspected secondary to UPJO. ERPF and nephrogram was arranged after insertion of ureteral catheter, which both showed non-functional kidney of ectopic kidney. CT with angiography before operation showed two separate sources of blood supply, and ectopic kidney over pelvis below the aortic bifurcation is identified. He was offered either an open radical nephrectomy or a laparoscopic radical nephrectomy and opted for the minimally invasive approach.


Results :

The operation was performed in trendelenburg lithotomy position without complications and blood loss about 50cc only. Patient was dischraged 4 days after operation. The diffculties in this case are site of port selection for approaching hilum, limited visual field of the pelvis, and identified localization of hilar vessels.


Conclusions :

Ectopic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply. We demonstrated and shared our experience in laparscopic technique for nonfunctioning pelvic kidney in expert laparoscopic surgeon, which appears to be efficient for decreased blood loss, shortened operative time, and safer a traditional open procedure. Overall, it is associated with an excellent outcome, minimal invasiveness, and short hospital stay.

Sheng-Feng Chou

Resident
China Medical University Hospital, Taichung, Taiwan
Taichung City, Taichung, Taiwan (Republic of China)

Chi-Rei Yang

Taichung City, Taichung, Taiwan (Republic of China)