Robotic Partial Nephrectomy for Isthmic RCC in a Horseshoe Kidney With Aberrant Aortic Arterial Supply

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Horseshoe kidneys present unique surgical challenges due to anomalous anatomy.
• Renal cell carcinoma (RCC) in horseshoe kidneys requires careful surgical planning for nephron-sparing approaches.

Purpose of the Study:

• To describe a case of robotic-assisted partial nephrectomy for an isthmic clear cell renal cell carcinoma (RCC) in a horseshoe kidney.
• To highlight the utility of advanced intraoperative imaging and techniques in managing complex renal masses.

Main Methods:

• Robotic-assisted partial nephrectomy was performed for a 4.6-cm clear cell RCC.
• Indocyanine green (ICG)-guided near-infrared fluorescence imaging and intraoperative ultrasonography were utilized.
• Aberrant aortic arterial branches supplying the tumor were identified and ligated.

Main Results:

• The surgery achieved negative surgical margins with a pathologic stage of pT1b.
• Postoperative recovery was uncomplicated, with preserved renal function.
• No tumor recurrence was observed at the 6-month follow-up.

Conclusions:

• Robotic-assisted partial nephrectomy is feasible and effective for RCC in complex horseshoe kidney anatomy.
• Detailed preoperative anatomic assessment and advanced intraoperative imaging are crucial for successful nephron-sparing surgery.
• This approach can lead to favorable oncologic and functional outcomes.