Laparoscopic Nephropexy: The Sliding Clip Technique

Abstract

Background: Nephroptosis is a clinical condition characterized by symptoms related to an abnormal caudal movement of the kidney. During the past decade, the availability of laparoscopic surgery has led to a revival of interest in nephroptosis. Most of the traditional surgical techniques aim to achieve kidney fixation by placing triangulation sutures between the abdominal wall and the renal capsule. These sutures are often difficult to tie because of the confined working space. Case Presentation: We herein present a case of a 31-year-old female patient who presented with symptomatic right-sided nephroptosis and was managed effectively by laparoscopic nephropexy. We have applied a technical modification to facilitate laparoscopic fixation by utilizing suture and nonabsorbable polymer clips ("sliding clip" technique). Conclusion: Laparoscopic nephropexy is a safe and effective procedure for the management of symptomatic nephroptosis. The "sliding clip" technique is a modification familiar to most urologists that facilitates intracorporeal suturing and adequate renal fixation.

Keywords: laparoscopy; mobile kidney; nephropexy; polymer clips.

FIG. 1.

Preoperative intravenous urogram. Intravenous urography in supine (left) and standing (right) position, confirming right-sided nephroptosis (arrows).

FIG. 2.

Intraoperative image. The existing adhesions between the kidney, the peritoneum, and the colon were released to completely mobilize the kidney (nephrolysis).

FIG. 3.

Renal fixation using the “sliding clip” technique. The sutures were passed through the superior and lateral surface of the kidney and the psoas and quadratus lumborum muscles (left), and were fixed using Hem-o-Lok clips, according to the “sliding clip” technique (right).

FIG. 4.

Restoration of peritoneal support. Attaching the right colon to the lateral abdominal wall, covering the kidney with the right colonic flexure and securing the kidney under the right liver lobe represent essential parts of an effective nephropexy.