V14-02 Robotic Retroperitoneal Partial Nephrectomy and Tumor Thrombectomy in a Horseshoe Kidney

You have accessJournal of UrologyAdrenal/Renal Oncology II (V14)1 May 2024V14-02 ROBOTIC RETROPERITONEAL PARTIAL NEPHRECTOMY AND TUMOR THROMBECTOMY IN A HORSESHOE KIDNEY Rogerio Huang and James Porter Rogerio HuangRogerio Huang and James PorterJames Porter View All Author Informationhttps://doi.org/10.1097/01.JU.0001008704.74547.03.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Horseshoe kidneys are the most common renal fusion anomaly, occurring in 0.25% of the population or 1 in 400 individuals. In most cases, the kidneys are joined at the lower poles by an isthmus which leads to kidneys that are low lying and malrotated. The blood supply can also be numerous and highly variable in origin. Due to the aberrant anatomy, surgical management of renal masses can be challenging. To date, there have been very few educational videos on retroperitoneal partial nephrectomy in a horseshoe kidney and none describing the management of a tumor thrombus. Our aim is to demonstrate such a case and highlight important technical considerations to carry out this approach in a safe and efficient manner. METHODS: This is a 63 year old male with an incidental 3 cm right renal mass in a horseshoe kidney. Preoperative imaging showed an endophytic hilar mass with central extension. Due to a prior ventral hernia repair with mesh and posterior location of the mass, a retroperitoneal partial nephrectomy was performed. Intraoperatively, ultrasonographic guidance was employed. The mass was seen extending into the renal vein and vena cava. After controlling the vena cava, en bloc resection of the mass with the renal vein and tumor thrombus was carried out. RESULTS: The total operative time was 360 minutes and the estimated blood loss was 300 mL. Warm ischemia time was 30 minutes. The patient was discharged on post-operative day 2. No post-operative complications were noted. Final pathology revealed a T3a N0 grade 2 clear cell renal cell carcinoma with negative margins. CONCLUSIONS: A robotic retroperitoneal partial nephrectomy with tumor thrombectomy in a horseshoe kidney is feasible in experienced hands. The retroperitoneal approach offers distinct advantages including excellent access to navigate aberrant anatomy, direct visualization of posterior tumors and avoidance of the peritoneum in patients with prior abdominal surgery. Further refinement of this technique and dissemination of these educational videos will hopefully enable more urologists to operate on horseshoe kidney masses. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1227 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rogerio Huang More articles by this author James Porter More articles by this author Expand All Advertisement PDF downloadLoading ...