Robotic Assisted Partial Nephrectomy in Ectopic Pelvic Kidney

Description

A 69 year old male was referred to our clinic for evaluation of incidental finding on a CT scan of a 4.1cm enhancing exophytic mass in a pelvic kidney, and duplication of the infrarenal inferior vena cava. Patient elected to undergo a robot assisted laparoscopic partial nephrectomy. He was positioned supine in steep Trendelenburg. Four 8mm robotic trocars were placed higher in the abdomen in pelvic surgery placement, as well as additional 12mm and 5mm assistant trocars. Monopolar scissors, bipolar grasper and tip up fenestrated grasper were used to reflect the colon off the kidney. Hilar structures were carefully isolated. The surface of the mass was exposed entirely, confirming its location with intraoperative ultrasound. Main and accessory renal arteries were clamped, and mass was excised entirely. Resection bed, Gerota and surgical incisions were closed in the standard fashion. Total clamp time was 8 minutes. Post operative course was uncomplicated and patient was discharged on post-operative day one. Pathology showed a 4.5cm papillary renal cell carcinoma tumor.