Robotic transmesocolonic Pyelolithotomy of horseshoe kidney.
BACKGROUND
The purpose of this video is to demonstrate the use of the robot to perform a transmesocolonic pyelolithotomy of a horseshoe kidney.


METHODS
A 35-year old female presented with vague abdominal pain. CT scan imaging revealed the presence of a left horseshoe kidney with multiple pelvicalyceal stones. The patient was positioned in the supine position. A total of 4 ports were introduced. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. First, the dilated renal pelvis was identified behind the thin mesocolon. The mesocolon was entered and renal pelvis was dissected completely from the surrounding fat. Then, the renal pelvis was opened after adequate dissection and stones were visualized inside the calyces. By Prograsp forceps, stones were removed from all the calyces under vision and were extracted from the assistant trocar. Finally, the pylotomy incision was closed using 4 0 Maxon in a continuous fashion and the mesocolon was closed using 3 0 PDS interrupted sutures. A JP drain was placed.


RESULTS
Operative time was forty-five minutes, blood loss was 100 ml. The patient was discharged after 48 hours with no immediate complications.


CONCLUSIONS
The utilization of minimal invasive surgery using the robot to extract multiple pelvicalyceal stones from a horseshoe kidney without reflecting the mesocolon proved to be a feasible and novel way in the management of complex stone disease improving the outcome with minimal morbidity.
Taibah University, College of Medicine, Madinah, Saudi Arabia.
Emad S
ES
Rajih
Department of Urology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
Mohammed F
MF
Al-Otaibi
Department of Urology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
Waleed K
WK
Alkhudair
D000328:Adult; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D008646:Mesocolon / Q000601:surgery; D061646:Operative Time; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome