V09-05 HORSESHOE KIDNEY ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY: A CASE SERIES

Abstract

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-05 HORSESHOE KIDNEY ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY: A CASE SERIES Daniel Au, David Duchene, and Andrew Zganjar Daniel AuDaniel Au More articles by this author , David DucheneDavid Duchene More articles by this author , and Andrew ZganjarAndrew Zganjar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Horseshoe kidneys are uncommon with an estimated incidence of approximately 1 in 500 persons. Horseshoe kidneys are characterized by arrested developmental ascent and are therefore located lower in the abdomen or pelvis. They are also typically malrotated with ureters passing over the isthmus or anterior to renal parenchyma and have widely variant renal vasculature. As many as 33% will have associated ureteropelvic junction obstruction. Various approaches to horseshoe kidney pyeloplasty have been used over the decades, more recently minimally invasive robotic approaches have been utilized. Owing to the unique anatomy of horseshoe kidneys there are several technical and anatomic considerations that should be considered and which we aim to demonstrate in this video. METHODS: Using a da Vinci robotic surgical system, we performed robotic assisted laparoscopic dismembered pyeloplasty on two patients with horseshoe kidneys and left ureteropelvic junction obstruction. We recorded this case series to demonstrate technical considerations, anatomy, and technique for performing robotic assisted laparoscopic pyeloplasty for horseshoe kidneys with ureteropelvic junction obstruction. RESULTS: Robotic assisted laparoscopic pyeloplasty is a safe and effective approach to the challenging anatomy ureteropelvic junction obstruction in horseshoe kidneys pose. Robotic ports should be placed inferior and medially compared to orthotopic pyeloplasty. CONCLUSIONS: Ureteropelvic junction obstructions are common in horseshoe kidneys and these can initially present in adulthood. Horseshoe kidneys differ from orthotopic kidneys in abdominal location, orientation, and vasculature. Horseshoe kidneys can be approached trans-mesenteric or by reflecting colon and mesentery medially. Ureteropelvic junction obstructions in horseshoe kidneys are typically high inserting with ureter stretched anteriorly over renal parenchyma. The goal of reconstruction is to re-anastomose the ureter to the most dependent portion of the renal pelvis. Crossing vessels are usually not an etiology of obstruction. Symphysiotomy (division of isthmus) is generally not recommended due to increased risk of infection, fistulas, leakages, and bleeding. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e688-e689 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Au More articles by this author David Duchene More articles by this author Andrew Zganjar More articles by this author Expand All Advertisement Loading ...