Pure Laparoscopic Radical Heminephrectomy for a Large Renal-Cell Carcinoma in a Horseshoe Kidney

Abstract

Introduction: Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. Presentation: A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed a 11 cm renal mass arising from the left moiety of an incidentally discovered horseshoe kidney. Preoperative CT angiography revealed a dominant anterior renal artery feeding the upper and midpole, with two other arteries feeding the lower pole and isthmus. The patient was placed in a modified flank position. A four-port transperitoneal technique was used, the colon was reflected. Renal pedicle was dissected and the renal arteries and renal vein were secured with polymer clips. The kidney was fully mobilized and a Satinsky clamp was placed on the isthmus for its division. A running 2-0 vicryl hand-sewn was used for parenchyma hemostasis. The specimen was extracted intact in a plastic bag through an inguinal incision. Results: The operative time was 220 minutes, and the estimated blood loss was 200 mL. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 2. Pathologic examination of the specimen confirmed a 11 cm organ--confined chromophobe renal-cell carcinoma, with negative margins. Discussion: Laparoscopic oncologic surgery in patients with horseshoe kidneys can be technically challenging. The presence of a large cancer in a horseshoe kidney should not preclude a purely laparoscopic approach. With the aid of a Satinsky clamp, the isthmus can be sharply divided and sutured in a fashion similar to the open technique. To our knowledge, this report represents the largest cancer (11 cm) removed laparoscopically in the context of a horseshoe kidney.

Laparoscopic Nephrectomy in Patients with Congenital Kidney Anomalies: Single-Centre Results

“…It has been reported that classical electrocautery, bipolar cautery, Endo GIA ® stapler (Covidien Healthcare, MA, US), parenchymal suture with satinsky clamp, endostapler, Harmonic Scalpel ® (Ethicon, UK), LigaSure ® (Covidien Healthcare, MA, US) methods can be reliably used in isthmus separation and bleeding control. 10,18 In our six cases, Endo GIA ® stapler (Covidien Healthcare, MA, US) was used on three, Harmonic Scalpel ® (Ethicon, UK) and parenchymal suturation on one, and Lig-aSure ® (Covidien Healthcare, MA, US) on two. No complications were found in this series.…”

Laparoscopic heminephrectomy for benign and malignant diseases of the horseshoe kidney

“…Sausville and coworkers claimed that transperitoneal approach is successful and reasonable with minimal morbidity in a HK affected by xanthogranulomatous pyelonephritis (24). Transperitoneal approach has been advocated for laparoscopic radical heminephrectomy and partial nephrectomy for malignant diseases in patients with HK (14,15,(18)(19)(20)(21)27). Conversely, Lee et al suggested retroperitoneal approach for laparoscopic partial nephrectomy in a HK for posterior and posterolateral lesions (26).…”

A Rare Case of a Renal Cell Carcinoma Confined to the Isthmus of a Horseshoe Kidney

“…Most HSK tumors are corrected with bilateral partial nephrectomies via division of the isthmus [ 9 – 11 ]. Our patient underwent a similar procedure but in this case it was not a simple division of the isthmus but a total excision of a tumor-containing isthmus.…”