V6-02: Robotic Pyelolithotomy in Ectopic Pelvic Kidney: Side Docking in Supine Position and a Four-Arm Approach

Video

Introductions and Objectives
Ectopic kidney is a congenital malformation occurring in 1 in 900 births. Only about one in 10 of these are diagnosed. Patients with ectopic kidneys can be completely asymptomatic and discovered incidentally or they present with symptoms owing to urinary tract infection, obstructive uropathy or nephrolithiasis. Ectopic kidneys with renal pelvic stones can be challenging to treat. We report our experience in managing a case of ectopic pelvic kidney with a renal pelvic stone by robotic pyelolithotomy. _x000D_ Our objective is to present our approach to Robotic Pyelolithotomy in the management of renal pelvic stone in ectopic pelvic kidney.

Methods
Our case is a 46 year old male with 2 months history of vague lower abdominal pain. No other urological symptoms. During his work-up a Computed Tomography (CT) scan showed left ectopic pelvic kidney with an 8 x 12 x 11 mm stone in an anomalous renal pelvis showing multiple compartments connected by narrow channels. Two attempts at flexible ureteroscopy (URS) failed to reach the stone. _x000D_ After placing a 4.7 French double J stent we proceeded with left pelvic robotic pyelolithotomy. Side docking was utilized with the patient in supine trendelenburg position. Port placements were similar to robotic assisted laparoscopic prostatectomy.

Results
Docking time was 35 minutes and total Console time was 150 minutes. There were extensive adhesions in the region of the left pelvic kidney. Multiple attempts failed to follow the course of the ureter in order to locate the renal pelvis. We subsequently opened the renal pelvis directly and used the flexible cystoscope to basket the stone out the renal pelvis through a narrow infundibulum. Estimated Blood Loss (EBL) was
Conclusions
Stones in ectopic pelvic kidneys pose a great challenge due to altered surgical anatomy. Robotic pyelolithotomy is a safe and feasible approach providing exceptional exposure and easier dissection. It is imperative to have a detailed understanding of ectopic kidney anatomy to ensure safety and procedure success. Utilization of flexible cystoscopy aided in the localization and extraction of the stone in an anomalous renal pelvis.

Funding: None