Robot-assisted laparoscopic pyeloplasty for horseshoe kidney in a child: a case report

The laparoscopic approach can be technically challenging in patients with a horseshoe kidney due to the specific anatomy, including caudal kidney position and rotation, aberrant vessels, and high ureteral origin. The use of robotic systems has facilitated the performance of this procedure. We conducted a retrospective review of the medical records of a 1-year-old child with ureteropelvic junction obstruction associated with a horseshoe kidney. Contrast-enhanced computed tomography was the primary diagnostic modality for identifying the cause of hydronephrosis and allowed accurate determination of the true source of obstruction, namely a high origin of the ureter from the renal pelvis. The patient underwent robot-assisted Anderson–Hynes pyeloplasty. The key differences from surgery in anatomically normal kidneys included caudal placement of robotic ports and meticulous assessment of the renal vascular anatomy. The procedure was successfully completed with robotic assistance without conversion to laparoscopy or open surgery. No intraoperative complications related to bleeding or injury to adjacent organs were observed. The total operative time, including robotic docking, was 165 minutes: docking time was 15 minutes, and total console time was 150 minutes. The hospital stay lasted 5 days. The pyelostomy tube was removed on postoperative day 7 in an outpatient setting. The anteroposterior diameter of the renal pelvis was measured preoperatively and 6 months after surgery. The renal pelvis diameter decreased from 37 mm to 8 mm. Radionuclide renal imaging showed no residual obstruction on diuretic renography. The results of this case confirm that robot-assisted laparoscopic pyeloplasty for horseshoe kidney is safe, feasible, and associated with favorable outcomes when performed by experienced surgeons.