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Laparoscopic Heminephrectomy Experience: Patient With Horseshoe Kidney

Alper Bitkin, Mevlüt Keleş, Mustafa Aydın, Lokman İrkilata, Caner Moral, Ebubekir Akgüneş, Ramazan İnan, Emrah Küçük, Mustafa Kemal Atilla
Samsun Trainig And Research Hospital, Department Of Urology, Samsun, Turkey

PURPOSE:
The aim of this video is to present our first laparoscopic heminephrectomy experience in right hydronephrotic atrophic kidney with fusion anomaly.(Horseshoe kidney)
MATERIAL-METHODS:
50 year old female patient refered to our clinic with right flan pain and recurrent urinary tract infection. In abdomen computarized tomography, there was a hydronephrotic right kidney with thinned parenchym and fusion anomally. (Horseshoe kidney). Renal scintigraphy showed that seperated kidney funtions was %0.7 for rigt kidney and %99.3 for the left one, respectively.
Laparoscopic heminephrectomy operation was planned. Operation performed by aid of three 10 mm and one 5 mm laparoscopic ports via transperitoneally. After the right ureter was found, right renal pedicle and pedicular structures were released. The hydronephrotic right kidney was liberalizated from surrounding tissues. By this time, the fibrotic band which is the sign of fusion anomally, was seen in the lower pole wall. Firstly, right ureter was binded with hemoclips, then cutted. Later, renal artery and renal vein were binded and cutted, respectively. After that the hydronephrotic right kidney was drained with aspirator and the fibrotic band was defined clearly. Lastly, the fibrotic band was dissected through the intact left renal parenchym. Band sutured and controlled with 2.0 absorbable(vicryl) sutures, then cutted and seperated. The fusion line sutured with 2.0 absorbable(vicryi) sutures individually and blood control was provided. Heminephrectomy material was taken out with body bag and a silicone drain placed to the surgical field.
FINDINGS:
Operation took 125 minutes and bleeding was 100 cc, totally. Urethral cathether was taken at the first postoperative day and the drain was taken at the second postoperative day and the patient was discharged.
CONCLUSION:
Horseshoe kidney is the most common type of renal fusion anomallies and in patients with horseshoe kidney anomally, all renal surgical procedures become more difficult. But in experienced hands, laparoscopic surgery is an effective and reliable method for these patients.


Horseshoe Kidney Laparoscopic Heminephrectomy