Robot-Assisted Laparoscopic Calyceal Diverticulectomy: A Safe and Feasible Technique

Abstract

Clinical History and Physical Examination:

A 15-year-old female with Saethre–Chotzen syndrome without history of urinary tract infections or kidney stones presented with a 2-week history of fever, emesis, and left flank pain. Physical examination revealed left costovertebral angle tenderness and mild left upper quadrant pain to deep palpation.

Diagnosis:

CT of abdomen revealed a 6.6-cm renal abscess in the upper left kidney. A drain was placed by interventional radiology and subsequent antegrade studies revealed a calyceal diverticulum (CD).

Intervention:

After two unsuccessful interventions through endoscopic approaches, a robotic intervention was performed. First, a 5F ureteral catheter was placed through cystoscopy. The CD was then identified with the help of the prior nephrostomy tube placed on it. The CD was unroofed with a vessel sealer. The ostium was closed, and an omental flap was placed within the diverticular cavity. A closed suction drain, a left ureteral stent, and an indwelling Foley were left to optimize drainage. Operative time was 280 minutes. Estimated blood loss was 50 mL. A regular diet was started on postoperative day (POD) 1. She was discharged on POD 4.

Follow-Up:

The Foley catheter, drain, and ureteral stent were removed sequentially on POD 2 and POD 9 and 7 weeks later, respectively. At 12-month follow-up, she remained asymptomatic.

Outcome:

A robotic approach is a safe and feasible treatment modality in symptomatic pediatric patients with CD when endoscopic management has failed, even in cases complicated by chronic infection as demonstrated in this video.

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

No competing financial interests exist.

No funding was received for this article.

Runtime of video: 4 mins 45 secs

Prior abstract presentations to: North America Urology Robotic Symposium (NARUS), Las Vegas, February, 2022; American Urology Association (AUA), New Orleans, May, 2022; European Society of Pediatric Urology (ESPU), Belgium, June 2022, NARUS 2022.