Laparoscopic nephron-sparing surgery for a tumor near the isthmus of a horseshoe kidney with a complicated blood supply

Abstract

A horseshoe kidney is a congenital kidney malformation commonly associated with complications such as hydronephrosis, renal calculi, and infections of the renal pelvis. Renal cell carcinoma is extremely rare in a horseshoe kidney; once it occurs, however, it is intractable because of vascular abnormalities. This is especially true in laparoscopic nephron-sparing surgery, even for tumors of <4 cm in diameter. We herein report a case involving an asymptomatic 65-year-old man with an incidental finding of a 4-cm solid mass near the isthmus of a horseshoe kidney on B-mode ultrasonography. Preoperative computed tomography of the renal artery revealed six arterial vessels supplying the affected kidney. Laparoscopic partial nephrectomy was performed. The outcome of this case suggests that laparoscopic nephron-sparing surgery might be a successful treatment method for a horseshoe kidney but that preoperative vessel evaluation and experienced laparoscopic skills are needed.

Laparoscopic retroperitoneal heminephrectomy for renal cell carcinoma in horseshoe kidney: a case report and review of the literature

“…In this case, we elected for a retroperitoneal heminephrectomy approach rather than a transperitoneal approach. Radical heminephrectomy in horseshoe kidney poses an entirely new challenge when approached retroperitoneally, especially with the variable anatomy of the blood vessels, aberrant vasculature, and the presence of an isthmus [ 16 – 19 ]. The isthmus can be bulky parenchymatous or fibrous and usually has its own blood supply [ 20 ].…”

Renal cell carcinoma of horseshoe kidney

“…If the tumor mass is localized at the poles, and its dimensions do not exceed 40 mm, the method of choice is sparing surgery, partial nephrectomy, which involves extraperitoneal and transperitoneal approach, or laparoscopic method using the same approaches [10]. When setting the indication for partial nephrectomy, three important characteristics of the horseshoe kidney must be taken into account: malformations of blood vessels, parenchymal or fibrous structure of the isthmus and the anatomical position of the kidney itself [11]. In about 30% of cases of horseshoe kidney, one renal artery was observed, while a large number of vascular anomalies are found in about 70% of cases.…”