V3-04: Robotic-assisted laparoscopic heminephrectomy: the retrograde technique

Video

Introductions and Objectives
We illustrate our “retrograde technique” for robotic-assisted laparoscopic heminephrectomy (RAL-HN). We also describe the clinical outcomes using this approach in the pediatric population with duplicated systems (DS).

Methods
A 5 year-old girl with history of right DS with a nonfunctioning upper moiety and hydroureter. On follow-up, she presented with urinary incontinence and febrile UTI. At this point, a recommendation for HN was made. A retrograde technique was used to help identify vasculature to the diseased moiety. The diseased moiety ureter is separated from the healthy moiety and transected, it is then passed posterior to the renal hilum cranially to allow better visualization of the vascular anatomy.

Results
The surgery was uncomplicated. The patient was discharged on postoperative day 3 after an uneventful hospital stay. At one month of follow-up, she is dry and doing well. Ultrasound revealed a healthy lower moiety. We have completed thirteen transperitoneal RAL-HN between 2009 and 2013. Mean age at surgery was 24.7 months and mean operative time was 144 minutes, with an estimated blood loss of 11 cc. No patients required open conversion. Mean hospital stay was 2.1 days (1-3 days) and no major complications were observed. Mean follow up was 13.4 months. One patient required secondary ureterectomy for recurrent urinary tract infection and refluxing ureteral stump. No patients lost their remaining healthy moiety. Change in renal function based on nuclear scan of the duplex kidney ranged from -10.5% to +1% (median 0%).

Conclusions
RAL-HN is a safe surgical option for pediatric patients with duplex moieties with appropriate surgical outcomes. The retrograde technique allows easy identification of the upper moiety vessels and transection without traction on the hilum of lower moiety

Funding: None