renal pelvic ectopia is a relatively rare occurrence , with a reported incidence of 1 in 3000 autopsies . although no significant difference exists in the incidence among the sexes , a slightly higher propensity is present for the left side over the right . the majority of patients remain asymptomatic , with most ectopic kidneys discovered as incidental findings during radiological evaluation . however , surgical intervention is often required for those patients who suffer from recurrent infection , symptomatic ureteropelvic junction obstruction , calculi , or chronic pain . laparoscopic and laparoscopic - assisted approaches to pelvic kidneys and those for fused , crossed renal ectopia have previously been described for the treatment of calculi and for the removal of nonfunctioning kidneys . herein , we describe our technique for the removal of a symptomatic , pelvic kidney in a patient with end - stage renal disease ( esrd ) before a living - related renal transplant . a 58-year - old - man with esrd was referred by the renal transplantation service for removal of a symptomatic , pelvic right kidney before undergoing a planned living - related renal transplantation ( lrrt ) . the patient had been undergoing hemodialysis for 2 years and had a longstanding history of vague lower abdominal pain secondary to nephrolithiasis within the pelvic kidney and recurrent urinary tract infections . physical examination revealed a soft abdomen with a palpable mass in the right lower quadrant . contrast - enhanced computed tomography ( ct ) of the abdomen and pelvis with 3-dimensional ( 3-d ) reconstructions revealed the left kidney to be within its normal anatomical location and a sizable pelvic right kidney ( 85.52 cm ) with mild hydronephrosis containing a 2.5-cm calculus ( figure 1 ) . further imaging revealed the right renal artery to arise from the right common iliac artery , with the right renal vein draining into the left common iliac vein . several smaller accessory veins were also demonstrated to drain into the right internal iliac vein . the patient underwent a laparoscopic pelvic nephrectomy via a 3-port approach ( figure 2 ) . at the discretion of the renal transplant service , concomitant allograft renal transplantation was deferred secondary to concern over infection . following initial laparoscopic inspection , the pelvic right kidney was easily identified under the peritoneal reflection just anterior to the sacral promontory . the right external iliac artery was identified , and the parietal peritoneum incised along the root of the small bowel mesentery . dissection was continued over the kidney until the anteriorly located renal pelvis and ureter were identified . utilizing sharp and blunt dissection , the ureter was then divided , and the kidney freed from any remaining retroperitoneal attachments and placed within an endocatch bag . given the size of the pelvic stone , the specimen was not morcellated but was left intact within the endocatch bag . total operative time was 80 minutes , with an estimated blood loss of 80 ml . the patient was discharged home on postoperative day 3 and received an lrrt 6 weeks after having undergone the laparoscopic pelvic nephrectomy . contrast - enhanced computed tomographic scan of the pelvis , demonstrating the right pelvic kidney with a stone within the renal pelvis . ectopic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply . as such , adequate preoperative imaging is crucial , whether by 3-d ct scan or magnetic resonance angiography ( mra ) . in this instance , laparoscopy afforded the well - established benefits of diminished blood loss , shortened operative time , and faster convalescence versus a traditional open procedure . more importantly , the laparoscopic approach to the pelvic kidney avoided violation of the right iliac fossa , which was later used for renal allograft transplantation .
pelvic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply . 
 although minimally invasive approaches have been described for the management of benign conditions , only a handful of reports have described the use of laparoscopy for removal of ectopic or fused kidneys . 
 we describe the laparoscopic removal of a symptomatic pelvic kidney in a patient before renal transplantation .