V7-03: Robot assisted laparoscopic renal calyceal diverticulectomy
VideoIntroductions and Objectives
Renal calyceal diverticula are typically asymptomatic but may present with flank pain, hematuria, recurrent infections or calculi. When treatment is indicated, options include ureteroscopic, percutaneous, or laparoscopic approaches depending on anatomy. As in other laparoscopic surgery, robotic assistance can confer improved visualization and instrument articulation when more complex reconstruction is needed.
In this video, we demonstrate robotic excision of a renal calyceal diverticulum. After ureteroscopy was unable to identify the diverticular os, a 5 French ureteral catheter was left in place near the location of the diverticulum. The kidney was then approached in standard fashion for robotic renal surgery. The diverticulum was clearly seen from the exterior surface of the kidney and confirmed with intraoperative ultrasound. After the exterior wall of the diverticulum was excised the 5 French catheter was used to inject methylene blue in a retrograde fashion to identify the os. The os was closed and the urothelial lining ablated with cautery. A perirenal drain and double-J ureteral stent were placed at the conclusion of the case.
The patient was discharged home on the second post operative day. The drain was removed one week postoperatively with minimal output. At one month postoperatively the patient was recovering well.
The robotic approach is an option in the treatment of renal calyceal diverticula, especially when more complex reconstruction is needed. Retrograde injection via ureteral catheter can aid in identifying the diverticular os. The robotic approach should be chosen carefully and the potential benefits must be balanced against the increased costs and potential for even less invasive options when endoscopic approaches are feasible.