V11-05 RENAL VEIN TRANSPOSITION WITHOUT VENOUS OUTFLOW OCCLUSION

Abstract

You have accessJournal of UrologyTransplant, Misc GU Cancers & Bladder Reconstruction (non-cancer) (V11)1 Apr 2020V11-05 RENAL VEIN TRANSPOSITION WITHOUT VENOUS OUTFLOW OCCLUSION Kyle Rose*, Matthew Breite, Victor Davila, and Erik Castle Kyle Rose*Kyle Rose* More articles by this author , Matthew BreiteMatthew Breite More articles by this author , Victor DavilaVictor Davila More articles by this author , and Erik CastleErik Castle More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000945.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot assisted transposition of the renal vein has been described for Nutcracker Syndrome. Unfortunately, surgical repair requires clamping of the venous outflow of the kidney via the left renal vein, which may cause renal parenchymal injury. Our objective was to perform transposition of the renal vein while providing continuous venous outflow from the kidney to avoid venous congestion and renal parenchymal injury. METHODS: A thirty-two year old female with one-year history of left flank pain and inability to walk upright due to this pain. Her computed tomography scan revealed compression of the left renal vein under the superior mesenteric artery. She underwent a venogram with intravenous ultrasound, which demonstrated >90% narrowing of the left renal vein under the SMA, diagnostic for Nutcracker Syndrome. RESULTS: After positioning in Trendelenburg position and obtaining pneumoperitoneum, ports were placed similar to a robot assisted retroperitoneal lymphadenectomy procedure. The retroperitoneum was exposed by incising the posterior peritoneum and tacking this to the anterior abdominal wall. The inferior vena cava (IVC) was identified and skeletonized, with emphasis on identification and dissection of the left renal vein. Vascular control was obtained using modified Rummell tourniquets. During our dissection, we identified a dilated and prominent left gonadal vein. We anastomosed the distal aspect of the left gonadal vein to the IVC, to provide constant venous outflow from the left kidney during transposition of the left renal vein. With the left kidney draining through both the left renal and gonadal vein, the left renal vein was stapled flush with the IVC. We then performed left renal vein transposition by anastomosing the left renal vein to the IVC below the left of the previous insertion with Gore-Tex suture. Vascular clamps were removed to assess the integrity of the anastomoses, and hemostasis was excellent. Total estimated blood loss was 50mL, and total operative time was 3 hours and 19 minutes. Postoperative creatinine improved to 0.57 mg/dL from 0.75 mg/dL preoperatively. The patient was discharged on postoperative day one. At 6 weeks follow up, her flank/abdominal pain had completely resolved. CONCLUSIONS: Robot assisted renal vein transposition is a feasible and safe alternative to open transposition for Nutcracker Syndrome. Transposition of the left renal vein without venous outflow obstruction is possible when utilizing the native gonadal vein as a conduit to the IVC. Using this approach, adequate venous outflow can avoid nephron injury. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1015-e1016 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Rose* More articles by this author Matthew Breite More articles by this author Victor Davila More articles by this author Erik Castle More articles by this author Expand All Advertisement PDF downloadLoading ...