Laparoscopic Heminephrectomy of a Horseshoe Kidney

Abstract

These authors suggest that laparoscopic heminephrectomy is a feasible option in the surgical management of diseases of the horseshoe kidney and can be performed safely using a transperitoneal or retroperitoneal approach.

Laparoscopic heminephrectomy for benign and malignant diseases of the horseshoe kidney

“…Kidney stones develop in 20% to 60% of patients and may be related with obstruction and recurrent urinary tract infections. Renal cell carcinoma, the most common, accounts for 45% of all tumors in patients with HK (6). In our cases, urolithiasis (54%) was the most common etiologic factor whereas the others were ureteropelvic junction obstruction (38.5%) and renal cell carcinoma (7.5%), respectively.…”

“…The isthmus generally consists of parenchymatous tissue with its own blood supply (5). The isthmus mostly lies anterior to the aorta and vena cava but very rarely may pass between the inferior vena cava and the aorta or even behind both major vessels (6). Generally, 33% of all patients with HK are asymptomatic, and the anomaly gets noticed incidentally on radiologic examination.…”

Challenging situations in partial nephrectomy

“…Rates of other renal tumours are comparable to the general population. Renal cell cancer accounts for 45% of malignant lesions in horseshoe kidneys while Wilms' tumour accounts for 28% [47]. Transitional cell cancer and sarcoma account for 20% and 7% of tumours, respectively [45,47].…”

“…Anomalous arterial branches are identified and dissected out in preparation for hilar clamping. In a horseshoe kidney, most of the vessels are above the isthmus [47]. After tumour excision, reconstruction can be performed using standard running 3-0 monocryl and interrupted 0-Vicryl sutures for the parenchyma and capsule, respectively.…”

“…Several laparoscopic techniques have been described such as placing a Satinsky clamp on the isthmus prior to sharply dividing it and then running a 2-0 vicryl for parenchyma haemostasis [50], or clipping the isthmus with a 15-mm Hem-o-lok, dividing it with a Harmonic scalpel then tying a PDS Endoloop around the isthmus [47] . Or even transecting the renal isthmus using a laparoscopic stapler [48].…”