MAAUA: MAAUA 68th Annual Meeting Abstracts - Complex Robotic Renal Surgery in Horseshoe Kidneys

MAAUA 68th Annual Meeting Abstracts

Complex Robotic Renal Surgery in Horseshoe Kidneys
Andrew Harris, Brian Steixner, Pierre Mendoza, *Lindsey Parkes, C. William Schwab, II, David Lee, Daniel Eun
Hospital of the University of Pennsylvania, Philadelphia, PA

There is limited experience with performing robotic and laparoscopic surgery in horseshoe kidneys. We report the first robotic surgery case series on horseshoe kidneys using the daVinci-S system.
Six horseshoe kidney systems in 5 patients were evaluated for upper tract pathology. Two cases presented with unilateral symptomatic ureteropelvic junction obstruction (UPJO), one with bilateral UPJO, and two cases with endophytic, centrally located tumors measuring 3.5 cm and 6.5 cm. Five transperitoneal dismembered pyeloplasties, one with pyelolithotomy, and two partial nephrectomies were performed. For pyeloplasties, double J stents were placed percutaneously in an antegrade fashion. For partial nephrectomy, laparoscopic ultrasound imaging for tumor demarcation was performed using the daVinci Tile Pro feature. Renal tumors were excised sharply with ischemia provided by laparoscopic bulldogs. The renal defect was closed using Evicel and a sliding weck clip renorrhaphy technique.
All cases were completed without complication. One partial nephrectomy was converted to a completion total nephrectomy after base biopsy was positive. Mean operative time and EBL for unilateral pyeloplasty was 202 minutes and 50cc, respectively. The bilateral pyeloplasty, parital nephrectomy, and total nephrectomy had operative times of 458, 210, and 330 minutes respectively and blood loss of 100cc, 100cc, and 300cc respectively. All patients were discharged on POD#1.
To our knowledge, this is the first series describing robotic surgical management of horseshoe kidneys. In our experience, complex robotic surgery on horseshoe kidneys is safe and feasible. Even bilateral cases and large central tumors can be performed and managed much like conventional robotic kidney surgery.

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