Hand-assisted laparoscopic heminephrectomy in horseshoe kidney

Background and Purpose: Horseshoe kidneys are the most common renal fusion anomalies. In surgery on normal kidneys, the use of minimally invasive techniques has decreased morbidity and improved postoperative care. However, aberrant vasculature, abnormal kidney location, and the renal isthmus present technical challenges to the laparoscopic management of horseshoe kidneys. We describe a case of heminephrectomy using hand-assisted laparoscopic techniques. Methods: A 35-year-old female patient with a horseshoe kidney was evaluated for recurrent nephrolithiasis and infections. Despite multiple previous percutaneous stone removal procedures, she continued to have symptomatic nephrolithiasis in the atrophic and obstructed right renal moiety. A transperitoneal hand-assisted laparoscopic heminephrectomy was performed on the right side. The aberrant vessels were identified and divided while the renal isthmus was divided using an endoscopic stapler. Results: The operative time was 165 minutes, while the estimated blood loss was 200 mL. There were no intraoperative complications. Postoperative pain was minimal, and the hospital stay was 4 days. The patient remains asymptomatic 6 months after her partial nephrectomy, with stable renal function. Conclusion: Hand-assisted laparoscopic heminephrectomy provides a safe treatment option for patients with an atrophic, obstructed moiety in a horseshoe kidney.