Robotic assisted surgery for patients with horseshoe kidney: a review of feasibility and clinical considerations

Horseshoe kidney (HSK) is a renal congenital abnormality characterized by the fusion of the lower poles of both kidneys via an isthmus. In robotic assisted surgery, HSK presents challenges due to its atypical anatomy, including aberrant vasculature and restricted renal mobility, complicating operative planning and execution across urologic surgeries. This review investigates the feasibility of robotic assisted surgery in HSK, aiming to address the unique surgical considerations the abnormality poses.

A targeted literature review was conducted using PubMed as the central database. Search terms included "horseshoe kidney," "robotic," and "case report." Results were limited to studies published between 2020 and 2026. A total of 18 studies met the search criteria, including case reports and case series. Across procedures including radical and partial nephrectomy, nephroureterectomy, and pyeloplasty, robotic assisted surgery was demonstrated as feasible with favorable perioperative outcomes.

Robotic assisted surgery is a safe and effective surgical approach for patients with HSK. Success was credited to extensive preoperative planning and case-specific, tailored intraoperative strategy. Key techniques included the preoperative use of 3D-CT reconstructive imaging for vascular mapping, selective patient positioning to increase exposure of target anatomy, and the use of indocyanine green to control blood supply intraoperatively.