PMC4718300_01
The MRI (T2) scan (A) showed the horseshoe kidney in this patient, and MRU (B) demonstrated the left kidney is hydronephrosis and UPJO. MRI = magnetic resonance imaging, MRU = magnetic resonance urography, UPJO = ureteropelvic junction obstruction.
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F1
The magnetic resonance imaging and magnetic resonance urography scans demonstrated a horseshoe kidney with concomitant left UPJO and hydronephrosis (Figure 1A and B).
The patient was in a semilateral decubitus position and 5 ports position were illustrated in A, B, C. The da Vinci robotic-assisted laparoscopy system was assembled (D).
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F2
The patient was rolled into a semilateral decubitus position rotating the operative side up by 45 axially (Figure 2A). The 5 trocars placement was performed (Figure 2A and B).
The ectopic and ovary veins were divided (A). The isthmus of horseshoe kidney was separated, stitched, and divided (B, C). The pyeloplasty was performed (D).
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F3
The ectopic renal and left ovary veins were divided and cut, respectively (Figure 3A [see Video, Supplemental Video, which demonstrates the details of procedure]). The robotic dissector was placed under the isthmus when it was raised upward (Figure 3B and C [see Video, Supplemental Video, which demonstrates the details of procedure]). F6 double J stent was placed in an ante-grade manner, and then the posterior and anterior aspects of the pelvic-ureteric anastomosis were both done by the 4-0 absorbable running suture (Figure 3D). Finally, 1 drainage tube was placed (see Video, Supplemental Video, which demonstrates the details of procedure).
The IVP showed the good renal function and improved drainage at 11.5 months after surgery. IVP = intravenous pyelography.
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F4
Following up, the IVP exam showed this female patient had good renal function and improved drainage at 11.5 months after surgery (Figure 4).