Robotic Partial Nephrectomy in the Treatment of a Posterior Excluded Caliceal Diverticulum with a Renal Calculus

Abstract

Clinical History: A 64-year-old woman with a history of nephrolithiasis presented with intermittent severe left flank pain. CT scan showed a 1-cm left renal calculus within the periphery of the kidney. The renal parenchyma eroded around the calculus, suggesting a caliceal diverticulum (CD). Shockwave lithotripsy treatment of stone within the CD was ineffective. Owing to the supracostal location and averse to nephrostomy tube and ureteral stent, the patient opted for a partial nephrectomy (PN). Physical Examination: NAD, AAOx3. Abdomen was soft, nontender, and nondistended. No costovertebral tenderness. Diagnosis: Right CD with kidney stones. Intervention: Robot-assisted laparoscopic right PN with intraoperative ultrasonography was performed. The CD was noted with stones within, and extracted without incident. Warm ischemia time was 15 minutes with excellent hemostasis and repair. There were no intraoperative complications and the patient was stable after the procedure. Follow-Up/Outcomes: Patient had an uncomplicated hospital course and was discharged home on postoperative day 1. Pathology analysis was consistent with an excluded diverticulum with renal calculi. Postoperative noncontrast CT of abdomen/pelvis showed complete treatment of the stone burden and CD. Patient was symptom free at 1-, 3-, 6-, and 12-month follow-up visits and no stones were seen on imaging. Our series of patients includes the aforementioned patient who underwent a retroperitoneal PN and another patient who underwent transperitoneal PN for large upper pole CD. The second patient reported history of recurrent urinary tract infections, which have since resolved. Her 3-month CT was unremarkable and she is symptom free. Both patients were refractory to extracorporeal shockwave lithotripsy treatment done previously. No competing financial interests exist. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 4 mins 59 secs