Bilateral robotic nephrectomy using a supine robotic approach without repositioning through 8-18mm incisions in a young female with focal and segmenta

Description

Introduction: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern that is associated with nephrotic syndrome and end-stage renal disease. The associated heavy proteinuria represents a perioperative risk factor for complications after transplantation. Therefore, a bilateral nephrectomy before transplantation is recommended to stop protein loss by the kidneys.

Case presentation: A 19-year-old woman with therapy resistant FSGS had a persistently low serum albumin level requiring supplementation. A bilateral kidney embolization or surgical removal before listing for a kidney transplantation was required. To improve perioperative outcomes and cosmesis, she was scheduled for a robotic subumbilical access to avoid scar tissue in the upper abdomen.
The patient was positioned in a supine position with 30° head down. No repositioning of the patient during the whole case was required. The peritoneum was incised at the level of the ileocecal valve up to the ligament of Treitz. A hammock-like barrier is created by suturing both lateral edges of the parietal peritoneum to the anterior abdominal wall. Subsequently the renal hilum was dissected and the kidney mobilized. The renal vessels were clipped. A 18mm laparoscopic morcellator was introduced after extending the 12mm assistant trocar incision and the kidneys were removed through the morcellator.
Postoperative length of stay was 4 days. After successful removal of both kidneys, the patient was listed for a kidney transplant with priority given her age < 20 years.

Conclusions: Bilateral robotic nephrectomy using a subumbilical access and removal of the kidney using a morcellator is technically demanding but feasible.