ABSTRACT Introduction A horseshoe kidney is a rare congenital anomaly with complex vascular variations that increase surgical difficulty. Few reports have specifically addressed the vascular approaches in robot‐assisted surgery. Case Presentation A man in his 70s was diagnosed with right ureteral urothelial carcinoma in a horseshoe kidney. Preoperative imaging revealed a short renal artery arising posterior to the isthmus, suggesting difficulty with conventional surgical approaches. Surgery was initiated in the supine position using a medial approach, similar to the medial‐to‐lateral dissection used for sigmoid colon mobilization, with cranial dissection along the aorta to secure the vessel and isthmus, followed by repositioning and standard robot‐assisted nephroureterectomy. Intraoperative indocyanine green fluorescence was used to guide safe isthmus division. The procedure was completed safely without any perioperative complications. Conclusion A tailored approach based on detailed preoperative vascular assessment may facilitate safe and effective robot‐assisted surgery in patients with horseshoe kidney and complex vascular anatomy.
Kambe et al. (Thu,) studied this question.