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

We report robotic-assisted partial nephrectomy for isthmic clear cell renal cell carcinoma in a horseshoe kidney with aberrant aortic arterial supply. Intraoperative management utilized indocyanine green-guided near-infrared fluorescence imaging, intraoperative ultrasonography, and ligation of aberrant arterial branches supplying the mass. Pathology demonstrated a 4.6-cm WHO/ISUP grade 3 clear cell RCC, pathologic stage pT1b with negative surgical margins. Postoperative recovery was uncomplicated with preserved renal function and no recurrence at 6 months. This case highlights the importance of detailed anatomic delineation during nephron-sparing surgery in complex horseshoe kidney anatomy.