Laparoscopic horseshoe kidney isthmusectomy: four case reports

Horseshoe kidney is a congenital defect of the urinary tract that occurs in 0.25% of the general population. The indications for division of the isthmus of horseshoe kidney are controversial, and if done, it is during the concomitant removal of additional defects accompanying horseshoe kidney. The aim of this study was to evaluate the results of isthmusectomy of horseshoe kidney using laparoscopy. This paper presents cases of 4 patients who underwent isthmusectomy, dismembered pyeloplasty, and stone removal using laparoscopy. All patients were operated on by a transperitoneal approach using 4 trocars. In 3 patients, we cut the renal isthmus by means of bipolar scissors and then we closed the renal parenchyma using two continuous hemostatic Vicryl 1-0 stitches. In 1 patient, an endostapler was used for isthmusectomy. The total operative time ranged from 4.5 h to 5.5 h including simultaneous dismembered pyeloplasty in 3 patients. Blood loss ranged from 40 ml to 300 ml. Use of the endostapler greatly facilitated the procedure. There were no complications either during or after the procedure. In all patients, mobilization and oral nutrition were included on the first or second day. On the third day, all patients were ready to be discharged from the hospital. Long-term follow-up after treatment showed good results in all patients. Laparoscopy is an alternative to open surgery, particularly in the correction of congenital defects of the urinary tract. Although the indications for division of the isthmus of horseshoe kidney are controversial, laparoscopic technique in isthmusectomy is safe for patients, as shown by our results.