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LAPAROSCOPIC HEMINEPHRECTOMY OF A HORSESHOE KIDNEY USING MICROWAVE COAGULATOR
0022-5347/99/1615-1559/0
THEJ ( i i ~ t ~uts ~UROI.OCY . Copyright 0 1999 by
. h E H l C A N UROLOGICAI.
Vol. 161, 1559, May 1999 Printed in U.S.A.
A..SCCIATION, INC
LAPAROSCOPIC HEMINEPHRECTOMY OF A HORSESHOE KIDNEY USING MICROWAVE COAGULATOR KUNIHIRO HAYAKAWA, SHIRO BABA, TEIICHIRO AOYAGI, MASAKAZU OHASHI, HIROMICH ISHIKAWA AND MAKOTO HATA From the Departments of Urology, Ichikawa General Hospital, Tokyo Dental College, Chiba and Keio University School of Medicine, Tokyo, Japan
KEYWORDS:kidney, abnormalities, laparoscopy, nephrectomy
We performed laparoscopic heminephrectomy of a horseshoe kidney using a microwave coagulator for division of the isthmus. CASE REPORT
A 17-year-old man was referred to our hospital for right flank pain. An excretory urogram revealed no right kidney and malrotation of the left renal collecting system. Abdominal ultrasonography demonstrated a large complex cystic mass in the right renal region which was confirmed on computerized tomography to be a horseshoe kidney with severe hydronephrosis (part A of figure). After discussion of the indication and modes of nephrectomy, the patient and his family agreed to laparoscopic heminephrectomy. Preoperatively a right percutaneous nephrostomy was constructed to reduce the hydronephrosis and facilitate the laparoscopic procedure. Under general anesthesia, t h e patient was placed in the semilateral position on the left side and the body angle was adjusted as required by rotating the operating table. The camera port was positioned at the umbilicus and 3 , 10 mm. ports were placed in the midabdominal, pararectal and anterior axillary lines, respectively. Incision on the white line of Toldt and medial reflection of the ascending colon exposed the partly collapsed right part of the horseshoe kidney. Further dissection displayed the right ureter and the isthmus of the horseshoe kidney. The renal vein and artery were isolated and divided between clips, respectively. The supplying artery of the isthmus was not clearly detected, and so t h e isthmus was divided after coagulation with a microwave coagulator with 80 W. output (part B of figure). NO additional hemostatic technique was needed for the cut surface. After t h e right ureter was clipped and divided, the kidney was delivered and wrapped in an endoscopic bag. The Accepted for publication January 8, 1999.
total duration of the operation was 8 hours. Estimated blood loss was 560 ml. and no blood transfusion was required. Although the patient needed to stay longer in the hospital than expected due to a mild paralytic ileus which occurred on postoperative day 4, he was discharged home in excellent condition 12 days after the operation. An excretory urogram 2 months postoperatively revealed a well functioning leR kidney with no extravasation. DISCUSSION
To our knowledge 2 cases of laparoscopic heminephrectomy for horseshoe kidneys using gastrointestinal endoscopic stapler to divide the isthmus have been reported previously.l.2 In our case we used a microwave coagulator instead of a stapler to avoid extrusion of the staples into the collecting system. This microwave instrument has also been used for laparoscopic partial nephrectomy to manage the cut surface, and its efficacy and safety have been confirmed.3 Laparoscopic renal surgery requires long operation times, which can result in side effects, such as postoperative paralytic ileus, as in our case. However, with continued improvement in laparoscopic techniques and equipment, operation time can be shortened just as surgical invasiveness has been minimized. REFERENCES
P. and Pflueger, H.: Laparoscopic hemi-nephrectomy in a horseshoe kidney. Brit. J. Urol., 76: 140, 1995. 2. Donovan, J. F., Cooper, C. S., Lund, G. 0. and Winfield, H. N.: Laparoscopic nephrectomy of a horseshoe kidney. J. Endourol., 11: 181, 1997. 3. Kigure, T., Harada, T., Yuri, Y., Satoh, Y. and Yoshida. K.: Laparoscopic microwave thermotherapy on small renal tumors: experimental studies using implanted VX-2 tumors in rabbits. Eur. J . Urol., 3 0 377, 1996. 1. Riedl, C. R., Huebner, W. A,, Schramek,
A , computerized tomography shows severe right hydronephrosis and isthmus. B,Isthmus is divided using microwave coagulator
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THEJ ( i i ~ t ~uts ~UROI.OCY . Copyright 0 1999 by
. h E H l C A N UROLOGICAI.
Vol. 161, 1559, May 1999 Printed in U.S.A.
A..SCCIATION, INC
LAPAROSCOPIC HEMINEPHRECTOMY OF A HORSESHOE KIDNEY USING MICROWAVE COAGULATOR KUNIHIRO HAYAKAWA, SHIRO BABA, TEIICHIRO AOYAGI, MASAKAZU OHASHI, HIROMICH ISHIKAWA AND MAKOTO HATA From the Departments of Urology, Ichikawa General Hospital, Tokyo Dental College, Chiba and Keio University School of Medicine, Tokyo, Japan
KEYWORDS:kidney, abnormalities, laparoscopy, nephrectomy
We performed laparoscopic heminephrectomy of a horseshoe kidney using a microwave coagulator for division of the isthmus. CASE REPORT
A 17-year-old man was referred to our hospital for right flank pain. An excretory urogram revealed no right kidney and malrotation of the left renal collecting system. Abdominal ultrasonography demonstrated a large complex cystic mass in the right renal region which was confirmed on computerized tomography to be a horseshoe kidney with severe hydronephrosis (part A of figure). After discussion of the indication and modes of nephrectomy, the patient and his family agreed to laparoscopic heminephrectomy. Preoperatively a right percutaneous nephrostomy was constructed to reduce the hydronephrosis and facilitate the laparoscopic procedure. Under general anesthesia, t h e patient was placed in the semilateral position on the left side and the body angle was adjusted as required by rotating the operating table. The camera port was positioned at the umbilicus and 3 , 10 mm. ports were placed in the midabdominal, pararectal and anterior axillary lines, respectively. Incision on the white line of Toldt and medial reflection of the ascending colon exposed the partly collapsed right part of the horseshoe kidney. Further dissection displayed the right ureter and the isthmus of the horseshoe kidney. The renal vein and artery were isolated and divided between clips, respectively. The supplying artery of the isthmus was not clearly detected, and so t h e isthmus was divided after coagulation with a microwave coagulator with 80 W. output (part B of figure). NO additional hemostatic technique was needed for the cut surface. After t h e right ureter was clipped and divided, the kidney was delivered and wrapped in an endoscopic bag. The Accepted for publication January 8, 1999.
total duration of the operation was 8 hours. Estimated blood loss was 560 ml. and no blood transfusion was required. Although the patient needed to stay longer in the hospital than expected due to a mild paralytic ileus which occurred on postoperative day 4, he was discharged home in excellent condition 12 days after the operation. An excretory urogram 2 months postoperatively revealed a well functioning leR kidney with no extravasation. DISCUSSION
To our knowledge 2 cases of laparoscopic heminephrectomy for horseshoe kidneys using gastrointestinal endoscopic stapler to divide the isthmus have been reported previously.l.2 In our case we used a microwave coagulator instead of a stapler to avoid extrusion of the staples into the collecting system. This microwave instrument has also been used for laparoscopic partial nephrectomy to manage the cut surface, and its efficacy and safety have been confirmed.3 Laparoscopic renal surgery requires long operation times, which can result in side effects, such as postoperative paralytic ileus, as in our case. However, with continued improvement in laparoscopic techniques and equipment, operation time can be shortened just as surgical invasiveness has been minimized. REFERENCES
P. and Pflueger, H.: Laparoscopic hemi-nephrectomy in a horseshoe kidney. Brit. J. Urol., 76: 140, 1995. 2. Donovan, J. F., Cooper, C. S., Lund, G. 0. and Winfield, H. N.: Laparoscopic nephrectomy of a horseshoe kidney. J. Endourol., 11: 181, 1997. 3. Kigure, T., Harada, T., Yuri, Y., Satoh, Y. and Yoshida. K.: Laparoscopic microwave thermotherapy on small renal tumors: experimental studies using implanted VX-2 tumors in rabbits. Eur. J . Urol., 3 0 377, 1996. 1. Riedl, C. R., Huebner, W. A,, Schramek,
A , computerized tomography shows severe right hydronephrosis and isthmus. B,Isthmus is divided using microwave coagulator
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