V6-03: Laparoscopic Robot-Assisted Pyelolithotomy In An Ectopic Right Pelvic Kidney

Video

Introductions and Objectives
Percutaneous management of symptomatic stones in ectopic pelvic kidneys is considered challenging given the potential serious injuries to adjacent organs. This video demonstrates the implementation of da-Vinci robotic system in such case.

Methods
A 53 year old lady with a known right ectopic pelvic kidney and associated calculus was presented to our service._x000D_ Abdominal CT scan demonstrated a right, rotated, ectopic pelvic kidney located to the midline. Bifid pelvis was noted with a 25 mm stone in one of its limbs._x000D_ Given its location, we felt that percing this kidney may expose the patient to serious complications._x000D_ Alternative treatment options were discussed with the patient and she elected to undergo uretero-nephroscopy and stone fragmentation._x000D_ Retrograde pyelogram performed during the procedure demonstrated a highly inserted ureter. The stone was demonstrated contralateral to the insertion site._x000D_ Given the sharp angle between the stone and the ureter it was impossible to reach it with the flexible ureteroscope. _x000D_ Consequently, laparoscopic robot-assisted Pyelolithotomy was selected as the second line treatment._x000D_ Under general anesthesia, with a double J stent (DJS) and a foley catheter in place, the patient was placed in a steep Trendelenburg position._x000D_ A 12 mm incision was made approximately 4 cm above the umbilicus. Abdominal insufflation was carried out to a pressure of 15 mmHg. Another two robotic 8 mm trocars were placed 10 cm lateral to the right and to left of the camera port. On the patient's right, a 12 mm assistant trocar was placed just medial to and superior to the anterior iliac spine. Using robotic hook and fenestrated grasper the peritoneum was opened in its right portion at the level of the ectopic kidney. Perinephric fat was dissected in order to expose the renal pelvis._x000D_ The renal pelvis was subsequently opened and the stone was taken out and was placed in an endoscopic bag. Next, the pelvis was closed in two running layers of 3/0 Vicryl suture. Perinephric fat was re-approximated with another running layer of 3/0 vicryl suture. Peritoneum was closed with a running layer of 3/0 V-lock suture. Finally, a 7FR drain was left in the right gutter.

Results
Total operative time was 95 minutes. Estimated blood loss was 15 ml._x000D_ Post-operative course was uneventful. Foley catheter was taken out on post-operative day 2 and the drain the following day. The DJS was taken out 5 weeks later.

Conclusions
Robot-assisted laparoscopic pyelolithotomy may serve as an appropriate alternative to other minimally-invasive surgical techniques for the treatment of symptomatic stones in ectopic pelvic kidneys.

Funding: None