Laparoscopic Radical Heminephroureterectomy for Management of Urothelial Tumor in a Cross-Fused Ectopic Kidney: First Report

Abstract

Objective:

Previously, feasibility of laparoscopic heminephroureterectomy has been demonstrated for management of benign renal disease, but we report a unique case of laparoscopic radical heminephroureterectomy for S-shaped left-to-right crossed fused ectopic kidney in a 74-year-old man with transitional cell carcinoma.

Aim:

The aim of this video submission is to present a 7-minute video demonstrating the technical details of a transperitoneal laparoscopic heminephroureterectomy for management of malignant disease.

Technique:

The tumor was located in the pelvis of upper part of this complex. Radical heminephrectomy was performed using four ports after full mobilization of the ectopic kidney and its ureter and clamping the major vessels of involved kidney using clips. Then, the ureter was dissected free down to the bladder, laparoscopically. Distal ureter and bladder cuff were retrieved via a pfannenstiel incision, and specimen containing kidney, ureter, and bladder cuff was excised enblock.

Results:

Operative time was 165 minutes and estimated blood loss was 300 mL. There were no intraoperative complications. Patient was discharged at sixth postoperative day. Preoperative serum creatinine of patient was 2.1 mg/dL and in latest measurement in follow-up period was 1.9 mg/dL. The report of surgical pathology was low-grade T1. All surgical margins were free of tumor. After 6 months of follow-up, recurrence was not detected.

Conclusions:

Urothelial tumors of crossed fused ectopic kidney are rare events. Although the laparoscopic management of these tumors is technically feasible, further study is required for suggestion of this technique.

No competing financial interests exist.

Runtime of video: 7 mins