Laparoscopic Heminephrectomy in Crossed Fused Renal Ectopia with Complex Cyst

Abstract

Introduction:

Crossed fused renal ectopia (CFRE) is a rare congenital malformation, which presents when the kidney is located in the midline fused with the contralateral kidney. ^1,2 Clear cell renal carcinoma, although rare, is a condition that can be found in patients with CFRE. ³ The vascular anatomy of the kidney is atypical and preoperative radiologic evaluation is important to surgical planning. ⁴ Herein, we present a laparoscopic heminephrectomy in a patient with a complex cystic lesion in a CFRE.

Materials and Methods:

The patient is a 40 years old woman complaining of dysuria for 2 months. Urinalysis identified microscopic hematuria and ultrasonography showed a 3.9 × 3.5 cm cyst in the right kidney. Contrast-enhanced computed tomography showed CFRE to the right and a Bosniak IV cystic lesion in the right kidney, measuring 7.7 × 6.1 × 5.0 cm. The width of the fused portion of the parenchyma was 3.4 cm. Tc-99m dimercaptosuccinic acid scintigraphy showed mildly decreased relative tubular function in the left kidney. The preoperative estimated glomerular filtration rate (eGFR) was 53 mL/min per 1.73 m². Right laparoscopic heminephrectomy was indicated. To better study the renal and vascular anatomy, an angiotomography was performed. The patient was positioned in the left lateral decubitus. The renal artery and renal vein were clipped using Hem-o-lok^® and then divided. The isthmus was isolated and sectioned with an Echelon^® vascular stapler. An abdominal drain was placed.

Results:

The operative time was 130 minutes, with no intraoperative complications. The patient was discharged with preserved renal function. Six months after surgery and with nephrologic follow-up, the eGFR was 63 mL/min per 1.73 m². The histopathologic study showed cystic nephroma.

Conclusion:

Laparoscopic heminephrectomy in CFRE is an unusual procedure. Preoperative study of renal and vascular anatomy is recommended. The use of the vascular stapler is an option for sectioning the isthmus.

Ethics Committee:

The authors received and filed ethics committee consent for recording/publishing the video.

Patient Consent Statement:

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

No conflicts of interest to disclosure.

Runtime of video: 4 mins 17 secs