LAPAROSCOPIC MANAGEMENT OF RENAL TUMOR IN A HORSESHOE KIDNEY
Abstract
Horseshoe kidneys represent the most common renal fusion anomaly. Abnormal vasculature and the possibility of isthmusectomy are the primary issues that require attention when surgery is considered. The present study describes the case of a pure transperitoneal laparoscopic radical heminephrectomy for a large renal tumor in a horseshoe kidney. A solid renal tumor in the left moiety of a horseshoe kidney was incidentally detected in a 35-years-old woman during a routine abdominal ultrasound. Computed tomography (CT) identified a 7-cm enhancing mass supplied by three arteries in the left renal moiety, without any metastatic lesion.
The mobilization of the descending colon revealed the underlying kidney with a wide isthmus. The mobilization of the left side of the horseshoe kidney extending to the isthmus was carried out. The tumor was identified in the infero-anterior section of the left kidney. A 60-mm powered Echelon Flex Endopath Stapler was used for the division of the isthmus, while the renal arteries and veins were secured with a 35-mm stapler. Operative time was 135 min with estimated blood loss<100 ml. No complications occured.The patient was discharged on post-op day three. Pathology revealed a pT2N0M0 grade 3 ccRCC inflitrating the renal calices with free surgical margins.