V01-06 ROBOT ASSISTED PARTIAL NEPHRECTOMY IN CROSSED-FUSED ECTOPIA

Abstract

INTRODUCTION AND OBJECTIVE: Cross fused ectopic is a rare congenital malformation that results in a complex vascular and renal collecting system anatomy. Management of pathologies that may arise in crossed-fused ectopic kidneys should take this anatomic complexity in consideration and interventions should be planned based on this aberrant anatomy. Here in, we present a case of crossed fused ectopia with a large renal mass that underwent robot assisted partial nephrectomy. METHODS: A previously healthy 65 year old presented with vague lower abdominal pain and indigestion. Abdominal US imaging demonstrated a pelvic mass. Further evaluation with cross sectional imaging (non-enhanced MRI abdomen and pelvis) by outside provider demonstrated a 7 cm mass involving a left cross-fused ectopic kidney. Patient was referred for further management. Staging work up included contrast enhanced CT of the chest, abdomen and pelvis showed no evidence of metastasis. Further evaluation of her abdominal vascular anatomy was evaluated with CT angiogram. Patient was counseled regarding surgical management with nephron sparing robot assisted partial nephrectomy. RESULTS: Preoperative imaging demonstrated single left renal artery with early branching, two left renal veins and a single collecting system and ureter that was engulfed and obstructed by the mass. Intraoperatively, the patient was placed in a supine position. Standard sterile prep and drape was performed. Six robotic ports were inserted toward the right lower quadrant of the abdomen. Following that, she was placed in steep Trendelenburg. The robotic surgical system was docked. The large bowel was dissected and retracted. All the vessels were dissected at their origin from the major vessels. ICG dye was injected to help delineate the isthmus and preserve the right (orthotopic) renal pedicle while ensuring all the left vessels were clamped. Vessels were controlled with endovascular staplers. The isthmus was identified. However, a right partial nephrectomy was performed as well to ensure complete resection of the tumor. Renorrhaphy was performed in the standard manner. Patient had a smooth postoperative recovery with no complication and was discharged on postoperative day 1. Postoperative pathology revealed a T2b, Nx, M0 grade ¾ clear renal cell carcinoma with negative surgical margins. Six months postoperatively patient was asymptomatic. Her creatinine was 0.9 mg/dL and eGFR was 66 ml/min/BSA. Postoperative imaging showed no residual masses with no evidence of recurrence CONCLUSIONS: Robotic assisted partial nephrectomy in crossed-fused ectopic kidney is feasible. Proper preoperative evaluation of the renal vasculature is essential to guide intraoperative identification of the blood vessels Source of Funding: None