V7-10: Robot-Assisted Laparoscopic Nephroureterectomy of a Right Pelvic Kidney in a Pediatric Patient
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INTRODUCTION
Pelvic kidney occurs due to failure of the kidney to ascend normally from the pelvis during development. The condition is typically asymptomatic, but many patients are prone to ureteropelvic junction (UPJ) obstruction due to malposition or malrotation. Complications of pelvic kidney include infections, stones, and renal failure. Enhanced visualization and greater dexterity are needed to locate and to control anomalous blood vessels. Added difficulty is encountered in patients with adhesive disease from previous abdominal surgery such as those with a VP shunt. The robotic approach allows for better access to and for delicacy with deep pelvic structures. We aim to demonstrate the application and safety of a robotic approach to the pelvic kidney nephroureterectomy in the pediatric population._x000D_
METHODS
A 4 year old (16 kg) male with a history of hydrocephalus with VP shunt reported recurrent abdominal pain and emesis, and a right lower quadrant mass was noted on physical exam. Ultrasound demonstrated a right pelvic kidney with moderate hydronephrosis of the upper and lower pole moieties. MAG-3 nuclear medicine scan findings were difficult to interpret due to poor renal function. A DMSA scan revealed a split differential function of 8% on the right side, indicating severely impaired renal function. The patient underwent a robot-assisted laparoscopic nephroureterectomy of a right pelvic kidney._x000D_
RESULTS
The right pelvic kidney was removed without perioperative complications. Pathology revealed hydroureteronephrosis, marked glomerulosclerosis, and tubular hypertrophy/atrophy with chronic interstitial nephritis. Ultrasound at 6 weeks post-op demonstrated normal compensatory hypertrophy of the left kidney and an unremarkable right lower quadrant absent of fluid collections. _x000D_
CONCLUSION
Nephroureterectomy of a pelvic kidney is challenging due to anomalous renal vessels. The robotic approach allows for excellent visualization and for dissection of deep pelvic structures. Robotic nephroureterectomy of a pelvic kidney is feasible and successful in the pediatric population, and the presence of a VP shunt does not preclude this procedure. _x000D_
Funding: None