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Laparoscopic Partial Nephrectomy for Tumour Excision in a Horseshoe Kidney: Part II
european urology 51 (2007) 1433–1434
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Previous Month’s Discussion and Answer
Laparoscopic Partial Nephrectomy for Tumour Excision in a Horseshoe Kidney: Part II Alexander Tsivian a,b,*, Avraham Shtricker a,b, Shalva Benjamin a,b, A. Ami Sidi a,b a b
Department of Urologic Surgery, Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
1.
Discussion
A horseshoe kidney presents a unique anatomic challenge secondary to its low fixed location, abnormal vasculature, anterior renal pelvis, and presence of an isthmus. There are few reports of laparoscopic ablative and reconstructive surgery in horseshoe kidneys, of laparoscopic and retroperitoneoscopic heminephrectomies [1–4], and of hand-assisted pyeloplasty and isthmectomy [5]. Our literature survey revealed only one report of partial nephrectomy in a horseshoe kidney that had been performed by a retroperitoneal approach in a patient with a complex enhancing cyst [6]. To our knowledge, this is the first report of a partial nephrectomy in a horseshoe kidney carried out by means of a transperitoneal laparoscopic transperitoneal approach (Figs. 1–5). In our opinion, the choice of laparoscopic approach depends on tumour location: anterior, anterolateral, and isthmic locations are best approached transperitoneally, whereas posterior and posterolateral tumours are more suitable for a retroperitoneoscopic approach.
Fig. 1 – Dotted red line indicates ischemic zone border.
Fig. 2 – Arrows show line of resection in the anterior part of the isthmus.
DOI of original article: 10.1016/j.eururo.2006.10.052 * Corresponding author. Department of Urologic Surgery, E. Wolfson Medical Center, POB 5, Holon, 58100 Israel. Tel. +972 3 502 86 53; Fax: +972 3 502 81 99. E-mail address: [email protected] (A. Tsivian). 0302-2838/$ – see back matter
doi:10.1016/j.eururo.2006.10.053
1434
european urology 51 (2007) 1433–1434
EU-ACME question Which tumour location is more suitable for nephron-sparing surgery on a horseshoe kidney by the retroperitoneoscopic approach? A. B. C. D. Fig. 3 – Arrows show line of resection in posterior part of the isthmus.
Anterior Anterolateral Isthmic Posterior and posterolateral
The correct answer is D
References
Fig. 4 – Suturing of parenchyma with Vicryl 1 suture.
Fig. 5 – The renal tissue defect was repaired using Vicryl 1 sutures with pledgets of Hem-o-lok clips and Surgicel bolster.
[1] Riedl CR, Huebner WA, Schramek P, et al. Laparoscopic heminephrectomy in a horseshoe kidney. Br J Urol 1995; 76:140–1. [2] Donavan JF, Cooper CS, Lund GO, et al. Laparoscopic nephrectomy of a horseshoe kidney. J Endourol 1997; 11:181–4. [3] Kitamura H, Tanaka T, Miyamoto D, et al. Retroperitoneoscopic nephrectomy of a horseshoe kidney with renal-cell carcinoma. J Endourol 2003;17:907–8. [4] Bhayani SB, Andriole GL. Pure laparoscopic radical heminephrectomy and partial isthmusectomy for renal cell carcinoma in a horseshoe kidney: case report and technical considerations. Urology 2005;66:880. [5] Nadler RB, Thaxton CS, Kim SC. Hand-assisted laparoscopic pyeloplasty and isthmectomy in a patient with a horseshoe kidney. J Endourol 2003;17:909–10. [6] Molina WR, Gill IS. Laparoscopic partial nephrectomy in a horseshoe kidney. J Endourol 2003;17:905–6.
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Previous Month’s Discussion and Answer
Laparoscopic Partial Nephrectomy for Tumour Excision in a Horseshoe Kidney: Part II Alexander Tsivian a,b,*, Avraham Shtricker a,b, Shalva Benjamin a,b, A. Ami Sidi a,b a b
Department of Urologic Surgery, Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
1.
Discussion
A horseshoe kidney presents a unique anatomic challenge secondary to its low fixed location, abnormal vasculature, anterior renal pelvis, and presence of an isthmus. There are few reports of laparoscopic ablative and reconstructive surgery in horseshoe kidneys, of laparoscopic and retroperitoneoscopic heminephrectomies [1–4], and of hand-assisted pyeloplasty and isthmectomy [5]. Our literature survey revealed only one report of partial nephrectomy in a horseshoe kidney that had been performed by a retroperitoneal approach in a patient with a complex enhancing cyst [6]. To our knowledge, this is the first report of a partial nephrectomy in a horseshoe kidney carried out by means of a transperitoneal laparoscopic transperitoneal approach (Figs. 1–5). In our opinion, the choice of laparoscopic approach depends on tumour location: anterior, anterolateral, and isthmic locations are best approached transperitoneally, whereas posterior and posterolateral tumours are more suitable for a retroperitoneoscopic approach.
Fig. 1 – Dotted red line indicates ischemic zone border.
Fig. 2 – Arrows show line of resection in the anterior part of the isthmus.
DOI of original article: 10.1016/j.eururo.2006.10.052 * Corresponding author. Department of Urologic Surgery, E. Wolfson Medical Center, POB 5, Holon, 58100 Israel. Tel. +972 3 502 86 53; Fax: +972 3 502 81 99. E-mail address: [email protected] (A. Tsivian). 0302-2838/$ – see back matter
doi:10.1016/j.eururo.2006.10.053
1434
european urology 51 (2007) 1433–1434
EU-ACME question Which tumour location is more suitable for nephron-sparing surgery on a horseshoe kidney by the retroperitoneoscopic approach? A. B. C. D. Fig. 3 – Arrows show line of resection in posterior part of the isthmus.
Anterior Anterolateral Isthmic Posterior and posterolateral
The correct answer is D
References
Fig. 4 – Suturing of parenchyma with Vicryl 1 suture.
Fig. 5 – The renal tissue defect was repaired using Vicryl 1 sutures with pledgets of Hem-o-lok clips and Surgicel bolster.
[1] Riedl CR, Huebner WA, Schramek P, et al. Laparoscopic heminephrectomy in a horseshoe kidney. Br J Urol 1995; 76:140–1. [2] Donavan JF, Cooper CS, Lund GO, et al. Laparoscopic nephrectomy of a horseshoe kidney. J Endourol 1997; 11:181–4. [3] Kitamura H, Tanaka T, Miyamoto D, et al. Retroperitoneoscopic nephrectomy of a horseshoe kidney with renal-cell carcinoma. J Endourol 2003;17:907–8. [4] Bhayani SB, Andriole GL. Pure laparoscopic radical heminephrectomy and partial isthmusectomy for renal cell carcinoma in a horseshoe kidney: case report and technical considerations. Urology 2005;66:880. [5] Nadler RB, Thaxton CS, Kim SC. Hand-assisted laparoscopic pyeloplasty and isthmectomy in a patient with a horseshoe kidney. J Endourol 2003;17:909–10. [6] Molina WR, Gill IS. Laparoscopic partial nephrectomy in a horseshoe kidney. J Endourol 2003;17:905–6.