Robot-Assisted Partial Nephrectomy in a High-Complexity Renal Tumor in a Horseshoe Kidney

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Horseshoe kidney presents unique surgical challenges due to anatomical variations.
• Renal tumor surgery in horseshoe kidneys requires specialized techniques.
• Robot-assisted surgery offers potential advantages for complex cases.

Purpose of the Study:

• To present a robot-assisted partial nephrectomy for a complex renal tumor in a horseshoe kidney.
• To demonstrate the feasibility and outcomes of this approach.
• To highlight the role of 3D planning in such challenging surgeries.

Main Methods:

• A 33-year-old male with a 7.5-cm renal mass in a horseshoe kidney underwent robot-assisted partial nephrectomy.
• Three-dimensional CT reconstruction was used for pre-operative planning.
• Transperitoneal robotic approach with Da Vinci Si platform was employed.
• Tumor excision was performed with 20 minutes of warm ischemia and renorrhaphy.

Main Results:

• The procedure was completed in 150 minutes with no intraoperative complications or need for transfusion.
• Pathology confirmed clear cell renal cell carcinoma with negative surgical margins.
• The patient was discharged 72 hours post-surgery with preserved renal function.
• No recurrence was observed during 12 months of follow-up.

Conclusions:

• Robot-assisted partial nephrectomy is a viable option for selected patients with complex renal tumors in horseshoe kidneys.
• 3D planning is crucial for successful outcomes in these challenging anatomies.
• This technique allows for oncologically safe tumor removal while preserving renal function.