A Case of Renal Pelvic Cancer Complicated by Horseshoe Kidney Treated with RoboSurgeon Gasless Single-Port Retroperitoneoscopic Nephroureterectomy

Abstract

A 78-year-old man who had a horseshoe kidney (HSK) visited us because of gross hematuria and suspicious urine cytology. CT and MRI revealed a right renal pelvic tumor of 28 mm in diameter. He underwent gasless single-port retroperitoneoscopic nephroureterectomy with division of the isthmus via the right pararectal small incision using the RoboSurgeon system. Pathological diagnosis was invasive urothelial carcinoma, grade 3, pT3, pN0, LVI0, RM0. He was discharged from hospital on the 6th postoperative day without any perioperative complication. He has no evidence of disease clinically and radiologically 19 months after the operation. Only a few cases of upper tract urothelial carcinoma complicated by HSK treated with minimally invasive surgery have been reported in English literature. This is the first case successfully managed with RoboSurgeon gasless single-port retroperitoneoscopic nephroureterectomy.

Figure 1

(a) CT scan axial image. A 28 mm tumor is shown in the right renal pelvis. (b) T2-weighted MR image. Arrow indicates the isthmus of a horseshoe kidney. (c) Diffusion-weighted MR image. The tumor in the right renal pelvis shows high signal.

Figure 2

(a) A wound retractor was placed at the pararectal incision of 6 cm made in the right upper quadrant. (b) Nephroureterectomy was carried out by keeping the retroperitoneal working space made along the anatomical plane using the Omni-Tract retractor system and PLES retractors (an arrow head). Asterisks indicate blades of the Omni-Tract retractor system. (c) Isthmusectomy was conducted using a bipolar sealing device. A vessel loop was passed beneath the isthmus. (d) The right retroperitoneal after completion of right nephroureterectomy and isthmusectomy. A drain tube was placed here after extensive saline irrigation.

Figure 3

(a) A nodular pedunculated tumor measuring 3.2∗2.4∗1.0 cm in the right renal pelvis. Inset, magnified image of the tumor. (b) Gross appearance of formalin-fixed tumor section. Surgical margin was negative microscopically.