Laparoscopic nephroureterectomy in a patient with a left ventricular assist device

Abstract

Left ventricular assist device (LVAD) therapy is an established treatment option for select patients with advanced heart failure. Advances in technology and patient management have resulted in improved post-implant outcomes. Consequently, more patients with LVADs are presenting for evaluation and care of non-cardiac surgical disease. However, there is a paucity of literature regarding the optimal perioperative and surgical management of such patients. We present the case of a 71-year-old male with a HeartMate II (Thoratec Corporation, Pleasanton, CA) LVAD, who underwent a laparoscopic left nephroureterectomy for an upper urinary tract transitional cell carcinoma. His perioperative course was uneventful due to the multidisciplinary efforts of cardiac surgery, cardiac anesthesia, nephrology and urology. To our knowledge, this is the first reported case of a laparoscopic nephroureterectomy in a patient with a HeartMate II LVAD.

Fig. 1

Heartmate II left ventricular assist device.

Fig. 2

Left retrograde pyelography demonstrating significant filling defect within renal pelvis.

Fig. 3

Patient in right lateral decubitus position with port and extraction sites (in red) for nephroureterctomy identified and anatomic location of the HMII LVAD and driveline superimposed. (A) 5-mm assistants port; (B) 5-mm surgeons left hand port; (C) 10-mm camera port and (D) 10-mm surgeons right hand port which was extended into Gibson incision for extraction of specimen.