Robot-Assisted Nephropexy

Abstract

Introduction:Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usually with a change of two vertebral bodies or more than five cm apart. Although rare, it is one of the causes of chronic flank pain or of upper abdomen. The typical patient of renal ptosis is young, female, thin, with complaint of pain when in an upright position (1, 2).Objective:Demonstrate a robot-assisted nephropexy technique in a young woman diagnosed with symptomatic renal ptosis on the right kidney, confirmed by imaging tests.Materials and Methods:A 29-year-old female patient with a history of chronic right-sided pain and palpable renal mobility on physical examination. The diagnosis of renal ptosis was confirmed by ultrasound imaging, excretory urography (Figure-1), and renal scintigraphy with 99mTc-DTPA (Figure-2). She was submitted to a robotic-assisted right nephropexy with a polypropylene mesh fixing the right kidney to the ipsilateral psoas muscle fascia.Result:We reported a 96-minute surgical time. The patient was discharged in the first postoperative day. At the one-month follow-up, there was an important improvement of the symptoms, with normality renal function and imaging tests describing adequate renal positioning.Conclusions:Robotic-assisted nephropexy is feasible and can be an excellent minimally invasive alternative technique for the proposed surgery. We reported a shorter hospital stay and a faster postoperative recovery compared with the opened procedure.

A Systematic Review on Spinal Asymmetries in Case Studies of Unilateral Nephroptosis from a Viscerosomatic Point of View

“…According to our results, nephroptosis has shown to generate spinal adaptations, with a protective posture by means of a flank closure, achieved by lowering of the homolateral lower rib, iliac crest raising and/or homolateral side-bending, with multiple vertebral asymmetries. Our results also show that, in some cases, postural asymmetries disappear when the ptosis is corrected (in supine position [ 31 , 35 , 36 , 38 , 39 , 40 , 43 , 44 , 45 ] or after surgical treatment [ 27 , 29 , 31 , 34 , 42 ], but in some cases they only improve partly [ 28 , 33 ], probably as a consequence of a long-term attitude, long-term muscular activity and shortening.…”

“…Pain was reported in 16 of the 19 articles included in the review. This pain was located in the abdominal area or ipsilateral flank in 84.62% of cases [ 27 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Pain could also affect the spine, involving the lumbar area [ 41 ] and the right spinal area [ 42 ], and even follow a radiating distribution from the abdominal and lumbar areas to the groin [ 43 , 44 ].…”