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Laparoscopic radical nephrectomy in a pelvic ectopic kidney: keys to success.

Chung BI, Liao JC - JSLS (2010 Jan-Mar)

Bottom Line: The procedure was performed successfully without complications and with minimal blood loss.The case was marked both by difficulty in mobilizing the sigmoid colon and the limited working space of the pelvis, which made localization of the numerous hilar vessels challenging.Preoperative imaging to delineate anomalous vascular anatomy is mandatory, and ureteral catheter placement is helpful for intraoperative identification purposes.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Stanford University School of Medicine, Stanford, California 94305, USA. bichung@stanford.edu

ABSTRACT

Background and objectives: Laparoscopic radical nephrectomy of a pelvic kidney for renal cell carcinoma is a procedure with little precedent, but one that offers the advantages of the minimally invasive approach. We present our experience with this unique procedure.

Methods: A 64-year-old male with a history of end-stage renal disease was diagnosed with a 2.6-cm enhancing mass in a pelvic left kidney with 2 separate sources of blood supply. He was offered either an open radical nephrectomy or a laparoscopic radical nephrectomy and opted for the minimally invasive approach.

Results: The procedure was performed successfully without complications and with minimal blood loss. The case was marked both by difficulty in mobilizing the sigmoid colon and the limited working space of the pelvis, which made localization of the numerous hilar vessels challenging.

Conclusions: Laparoscopic radical nephrectomy for a pelvic ectopic kidney appears to be safe and efficacious. Success is dependent on familiarity with pelvic anatomy, optimal port placement, and preprocedure knowledge of the often-complicated vascular anatomy of the ectopic kidney. Preoperative imaging to delineate anomalous vascular anatomy is mandatory, and ureteral catheter placement is helpful for intraoperative identification purposes.

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2.6 cm mid to lower pole location of enhancing renal tumor (arrow).
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Figure 1: 2.6 cm mid to lower pole location of enhancing renal tumor (arrow).

Mentions: The patient is a 64-year-old male with a history of end-stage renal disease, secondary to hypertension and diabetes mellitus, who is hemodialysis dependent. During workup for renal transplantation, a computed tomography (CT) scan revealed an ectopic pelvic left kidney with a 2.6-cm enhancing mass located in the anterior portion of the mid to lower pole (Figure 1). The ectopic kidney measured 9.5 cm by 5.5 cm. The CT also revealed 2 separate sources of blood supply to the kidney. The first originated from the contralateral common iliac artery and vein and entered the kidney into the medial aspect. The second originated directly from the aorta and vena cava and entered the kidney from the anterolateral direction (Figure 2). Incidentally, the renal vein entering the vena cava was retroaortically located. The patient was offered laparoscopic radical pelvic nephrectomy and open pelvic radical nephrectomy and opted for the laparoscopic approach.


Laparoscopic radical nephrectomy in a pelvic ectopic kidney: keys to success.

Chung BI, Liao JC - JSLS (2010 Jan-Mar)

2.6 cm mid to lower pole location of enhancing renal tumor (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021314&req=5

Figure 1: 2.6 cm mid to lower pole location of enhancing renal tumor (arrow).
Mentions: The patient is a 64-year-old male with a history of end-stage renal disease, secondary to hypertension and diabetes mellitus, who is hemodialysis dependent. During workup for renal transplantation, a computed tomography (CT) scan revealed an ectopic pelvic left kidney with a 2.6-cm enhancing mass located in the anterior portion of the mid to lower pole (Figure 1). The ectopic kidney measured 9.5 cm by 5.5 cm. The CT also revealed 2 separate sources of blood supply to the kidney. The first originated from the contralateral common iliac artery and vein and entered the kidney into the medial aspect. The second originated directly from the aorta and vena cava and entered the kidney from the anterolateral direction (Figure 2). Incidentally, the renal vein entering the vena cava was retroaortically located. The patient was offered laparoscopic radical pelvic nephrectomy and open pelvic radical nephrectomy and opted for the laparoscopic approach.

Bottom Line: The procedure was performed successfully without complications and with minimal blood loss.The case was marked both by difficulty in mobilizing the sigmoid colon and the limited working space of the pelvis, which made localization of the numerous hilar vessels challenging.Preoperative imaging to delineate anomalous vascular anatomy is mandatory, and ureteral catheter placement is helpful for intraoperative identification purposes.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Stanford University School of Medicine, Stanford, California 94305, USA. bichung@stanford.edu

ABSTRACT

Background and objectives: Laparoscopic radical nephrectomy of a pelvic kidney for renal cell carcinoma is a procedure with little precedent, but one that offers the advantages of the minimally invasive approach. We present our experience with this unique procedure.

Methods: A 64-year-old male with a history of end-stage renal disease was diagnosed with a 2.6-cm enhancing mass in a pelvic left kidney with 2 separate sources of blood supply. He was offered either an open radical nephrectomy or a laparoscopic radical nephrectomy and opted for the minimally invasive approach.

Results: The procedure was performed successfully without complications and with minimal blood loss. The case was marked both by difficulty in mobilizing the sigmoid colon and the limited working space of the pelvis, which made localization of the numerous hilar vessels challenging.

Conclusions: Laparoscopic radical nephrectomy for a pelvic ectopic kidney appears to be safe and efficacious. Success is dependent on familiarity with pelvic anatomy, optimal port placement, and preprocedure knowledge of the often-complicated vascular anatomy of the ectopic kidney. Preoperative imaging to delineate anomalous vascular anatomy is mandatory, and ureteral catheter placement is helpful for intraoperative identification purposes.

Show MeSH
Related in: MedlinePlus