Tailored Vascular Approach in Robot-Assisted Nephroureterectomy for a Horseshoe Kidney: A Case Report

A horseshoe kidney is a rare congenital anomaly with complex vascular variations that increase surgical difficulty. Few reports have specifically addressed the vascular approaches in robot-assisted surgery.

A man in his 70s was diagnosed with right ureteral urothelial carcinoma in a horseshoe kidney. Preoperative imaging revealed a short renal artery arising posterior to the isthmus, suggesting difficulty with conventional surgical approaches. Surgery was initiated in the supine position using a medial approach, similar to the medial-to-lateral dissection used for sigmoid colon mobilization, with cranial dissection along the aorta to secure the vessel and isthmus, followed by repositioning and standard robot-assisted nephroureterectomy. Intraoperative indocyanine green fluorescence was used to guide safe isthmus division. The procedure was completed safely without any perioperative complications.

A tailored approach based on detailed preoperative vascular assessment may facilitate safe and effective robot-assisted surgery in patients with horseshoe kidney and complex vascular anatomy.