Laparoscopic Nephro-Sparing Surgery of a Reninoma Tumor in a Pediatric Patient

Abstract

OBJETIVEReninoma, or juxtaglomerular cell tumor, is a benign neoplasm which causes severe hypertension with elevated plasma renin activity.1-3 Usually, it is well localized on computed tomography scan or magnetic resonance images, and complete resection of the tumor with renal function preservation is the optimal treatment.2-4To describe the technique of a transperitoneal nephron-sparing laparoscopic surgery in a pediatric patient. MATERIAL AND METHODSDescribe the technique of a minimally invasive nephron-sparing surgery for resection of a reninoma tumor in a child. RESULTSIn a 14-year-old girl with history of severe high blood pressure, ultrasound detected a hypoechoic lesion in right kidney.Angio computed tomography scan confirmed a 20-mm diameter lesion in the anterior surface of the lower pole of right kidney and also informed a lower pole renal artery.Transperitoneal laparoscopic approach was performed using 4 ports. After mobilization of the colon, Gerota's fascia was opened and the tumor identified. Both polar and principal renal arteries were dissected and secured with vessel loops. The tumor was resected using an ultrasonic energy device. Selective clamping of the lower pole renal artery was performed during 8 minutes. The transected renal surface was closed with two continuous barbed sutures and the tumor was removed using a handmade endobag. Perirenal drainage was left for 4 days, there were no perioperative complications and the patient was discharged 2 days after surgery. Pathology confirmed typical reninoma immunohistochemical features. Blood pressure and plasma renin levels returned to normal. Postsurgical scintigraphy informed 40% differential function of the right kidney. CONCLUSIONReninoma is a benign renal tumor and because of its nature and localization, minimally invasive nephron-sparing surgery should be considered.Strategic planning of the surgery based on preoperative images is essential. If vessel clamping is imperative, minimizing ischemia time and/or selective clamping, when possible, help preserve renal function.