Prevention of ureteral injury during laparoscopic colorectal cancer surgery with horseshoe kidney using fluorescent ureteral catheters: a case report

Abstract

Background Horseshoe kidney is one of the most common congenital renal fusion anomalies and is characterized by abnormalities in the position, rotation, vascular supply, and ureteral anatomy of the kidney. When performing surgery for colorectal cancer in patients with horseshoe kidneys, anatomical identification is important to avoid organ injuries. Several reports on surgery for colorectal cancer with horseshoe kidneys have described the usefulness of three-dimensional (3D) computed tomography (CT) angiography for detecting abnormalities in vascular supply. However, few reports have focused on the prevention of ureteral injury in surgery for colorectal cancer with horseshoe kidney, despite abnormalities in the ureteral anatomy. Here, we report a case in which laparoscopic sigmoid colon resection for sigmoid colon cancer with a horseshoe kidney was safely performed using fluorescent ureteral catheters. Case presentation A 60-year-old Japanese man presented to our hospital testing positive for fecal occult blood. Colonoscopy revealed sigmoid colon cancer, and CT confirmed a horseshoe kidney. The 3D-CT angiography showed aberrant renal arteries from the aorta and right common iliac artery, and the left ureter passed across the front of the renal isthmus. A fluorescent ureteral catheter was placed in the left ureter before the surgery to prevent ureteral injury. Laparoscopic sigmoid colon resection with D3 lymph node dissection was performed. The fluorescent ureteral catheter enabled the identification of the left ureter that passed across the front of the renal isthmus and the safe mobilization of the descending and sigmoid colon from the retroperitoneum. The operative time was 214 min, with intraoperative bleeding of 25 mL. The patient’s postoperative course was good: no complications arose and she was discharged on the seventh postoperative day. Conclusion In patients with horseshoe kidney, the use of fluorescent ureteral catheters and 3D-CT angiography enables safer laparoscopic surgery for colorectal cancer. We recommend the placement of fluorescent ureteral catheters in such surgeries to prevent ureteral injury.

Robot‐assisted laparoscopic surgery for rectal cancer in a patient with a horseshoe kidney: A case report

“…Placement of a fluorescent ureteral catheter to prevent intraoperative ureteral injury has been recommended. 3 The superior descending abdominal nerve has been reported to travel ventral or dorsal to the F I G U R E 2 Schematic of port placement and intraoperative image after initiation of medial approach. Four robotic ports (blue circles) plus a laparoscopic port (orange circle) for the assistant are placed.…”

“…The ureter and gonadal arteriovenous vessels are reported to often travel anterior to the kidney, although cases involving abnormal running of the ureter or duplicate ureters have been reported. Placement of a fluorescent ureteral catheter to prevent intraoperative ureteral injury has been recommended 3 . The superior descending abdominal nerve has been reported to travel ventral or dorsal to the descending renal isthmus, and it is important to understand the relationship between the vasculature and the horseshoe kidney as much as possible through preoperative imaging evaluation 1,4 …”

“…Its incidence is about 0.25%, and it is often associated with vascular, ureteral, gonadal, and neural anomalies. 1 Recently, there have been some case reports of laparoscopic surgery for sigmoid colon cancer or rectal cancer with a horseshoe kidney, [1][2][3][4][5] but no reports of robot-assisted surgery were found. In this report, a case of robot-assisted, laparoscopic, low anterior resection for rectal cancer in a patient with a horseshoe kidney is described.…”