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Surgical Planning for Carcinoma in Horseshoe Kidneys Treated with Retroperitoneoscopic Partial Nephrectomy
Zhiyu Zhang1, Jianglei Zhang1, Jun Ouyang1
1Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Insights
Retroperitoneoscopic surgery is a viable option for removing tumors from horseshoe kidneys (HSK). This approach, including partial or heminephrectomy, is feasible despite complex anatomy in HSK patients.
Area of Science:
- Urology
- Surgical Oncology
- Congenital Abnormalities
Background:
- Horseshoe kidney (HSK) is a common congenital anomaly affecting 1 in 400–1000 individuals.
- Tumor resection in HSK presents surgical challenges due to complex vascular anatomy, limited mobility, and tumor location.
Observation:
- Two cases of tumors arising from HSK are presented.
- Case 1: A 55-year-old woman with a 3.0-cm HSK tumor underwent retroperitoneoscopic partial nephrectomy.
- Case 2: A 50-year-old man with a 3.4-cm HSK tumor underwent retroperitoneoscopic heminephrectomy after arterial embolization.
Findings:
- Retroperitoneoscopic partial and heminephrectomy were successfully performed in both HSK tumor cases.
- Detailed 3D imaging and digital subtraction angiography were crucial for surgical planning, especially regarding tumor vascularity.
Implications:
- Retroperitoneoscopic surgery offers a feasible approach for managing tumors in horseshoe kidneys.
- The choice between partial and heminephrectomy depends on tumor characteristics, including location and vascular supply.
Abstract:
Horseshoe kidney (HSK) is a common congenital disease. Its incidence ranges from 1 in 400 to 1 in 1000, and it is often associated with chromosomal aneuploidies. Surgical approaches for tumor arising from HSKs are challenging because of the complicated vessel anatomy, poor mobility, and mass location. We report two patients diagnosed with tumors in HSKs who underwent retroperitoneoscopic partial- or heminephrectomy. Case 1: A 55-year-old woman presented to the hospital complaining of recurrent back pain. A 3.0-cm tumor mass in a HSK and polycystic kidney was revealed on CT. Three-dimensional (3D) imaging revealed a parenchymal fusion in the superior pole of the left moiety of the HSK, supplied by two main arteries from the aorta. The patient underwent retroperitoneoscopic partial nephrectomy using the four-trocar technique. Case 2: A 50-year-old man was referred to the hospital for further examination of a left renal tumor in his HSK discovered on CT. 3D imaging revealed a 3.4-cm mass arising from the left moiety of a HSK with invasion of the left renal sinus. There were five arteries feeding the tumor. The patient underwent retroperitoneoscopic heminephrectomy after embolization of the main artery supplying the tumor, guided by digital subtraction angiography with the four-trocar technique. Retroperitoneoscopic surgical approaches are feasible for resection of tumors from HSKs. The option of retroperitoneoscopic partial- or heminephrectomy depends on the location and blood supply of the tumor.
