Robot-Assisted Radical Nephrectomy for Renal Cell Carcinoma in a Pelvic Kidney: Case Report

A 79-year-old Japanese man developed a low abdominal mass. Contrast-enhanced computed tomography revealed a left-sided pelvic kidney measuring 60 mm, suggestive of renal cell carcinoma. Abnormal vascular anatomy was also noted, including three renal arteries arising from the abdominal aorta, umbilical artery, and inferior mesenteric artery, respectively. On the basis of these findings, we performed robot-assisted radical nephrectomy with placement of fluorescent ureteral stents to facilitate intraoperative identification of both ureters. The patient was positioned in steep Trendelenburg, and the pelvic kidney was removed safely. The console time was 156 min, and the estimated blood loss was 20 mL. To our knowledge, this is the first case of robot-assisted radical nephrectomy for renal cell carcinoma arising in a pelvic kidney. Steep Trendelenburg positioning and placement of fluorescent ureteral stents were key to achieving a favorable surgical outcome.