Robot-assisted heminefrectomy in a patient with duplex kidney: а case report

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Abstract

Robot-assisted surgery is a relatively new technology that enables a wide range of urological procedures to be performed using a minimally invasive approach. Various studies have shown that this technology is feasible and safe in most pediatric patients.

The authors of this study conducted a retrospective review of the medical history of a child with a doubling of the upper urinary tract, accompanied by obstructive damage to the upper segment of the ureter with loss of its excretory function. The data collection included the patient's medical history and demographic data, diagnosis, type of surgery, total time of surgery, outcome of surgery, and the anatomical and functional state of the kidney during follow-up.

A 12-year-old girl presented to the surgical department with complaints of recurrent urinary tract infections and right flank pain for the last year of her life. Robot-assisted laparoscopic heminephrectomy (RALHN) was performed using the Versius surgical robot. The upper segment ureter was transected at the lower pole of the kidney. The afunctional portion of the kidney was dissected from the normal kidney using a bipolar coagulation clamp. The lower segment incision edges were left open. The distal ureter was then isolated and sealed with a clip. The robot-assisted laparoscopic heminephrectomy procedure was successfully performed without intraoperative complications. The surgery duration was 225 minutes, including 20 minutes for robotic insertion. The total console time was 205 minutes. The drainage tube was removed after a follow-up ultrasound examination on the second day. The stent remained in the lower segment ureter until its removal six weeks after surgery. A repeat ultrasound examination performed postoperatively demonstrated no dilation of the lower segment pelvis or fluid collections in the area of the right kidney. Blood flow to the residual segment of the right kidney was not impaired.

The advantages of the robotic approach to treating upper urinary tract duplication, including improved instrument maneuverability and 3D visualization, make it a safe and effective alternative to open or laparoscopic surgery in children.

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About the authors

Yury A. Kozlov

Irkutsk State Regional Children's Clinical Hospital; Irkutsk State Medical Academy of Postgraduate Education; Irkutsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X
SPIN-code: 3682-0832

MD, Dr. Sci. (Medicine), Professor, corresponding member of the Russian Academy of Sciences

Russian Federation, Irkutsk; Irkutsk; Irkutsk

Alexander P. Rozhanski

Irkutsk State Regional Children's Clinical Hospital; Irkutsk State Medical University

Author for correspondence.
Email: alexanderozhanski@mail.ru
ORCID iD: 0000-0001-7922-7600
SPIN-code: 4012-7120
Russian Federation, Irkutsk; Irkutsk

Eduard V. Sapukhin

Irkutsk State Regional Children's Clinical Hospital

Email: sapukhin@уandex.ru
ORCID iD: 0000-0001-5470-7384
Russian Federation, Irkutsk

Alexey S. Strashinsky

Irkutsk State Regional Children's Clinical Hospital

Email: leksus-642@yandex.ru
ORCID iD: 0000-0002-1911-4468
Russian Federation, Irkutsk

Marina V. Makarochkina

Irkutsk State Regional Children's Clinical Hospital

Email: makarochkina@igodkb.ru
ORCID iD: 0000-0001-8295-6687
SPIN-code: 4600-4071
Russian Federation, Irkutsk

Andrey A. Marchuk

Irkutsk State Regional Children's Clinical Hospital

Email: maa-ped20@yandex.ru
ORCID iD: 0000-0001-9767-0454

MD

Russian Federation, Irkutsk

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Supplementary files

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2. Fig. 1. Computed tomographic urography (arrow): complete doubling of the upper urinary tract: coronary (a) and axial (b) sections.

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3. Fig. 2. Transverse intersection of the upper segment of the ureter and its passage behind the kidney gate.

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4. Fig. 3. Resection of the upper segment of the kidney.

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