Clampless Robotic Left Renal Vein Transposition
Matthew Breite, M.D., Victor Davila, M.D., Erik Castle, M.D., Kyle Rose, M.D..
Mayo Clinic - Arizona, Phoenix, AZ, USA.
INTRODUCTION AND OBJECTIVES:
Renal nutcracker syndrome describes symptomatic left renal vein compression, typically between the superior mesenteric artery and aorta. The diagnosis is often confounded by generalized abdominal and flank symptoms and frequently requires a multidisciplinary evaluation. We present the case of a 29-year-old female experiencing debilitating left flank and left lower quadrant pain with hematuria in the setting of left renal vein compression. Preoperative venogram demonstrated an elevated venous pressure differential between the left renal vein and inferior vena cava with venous reflux. A dilated left gonadal vein was identified during the venogram.
The patient underwent robotic left renal vein and left gonadal vein transposition. The procedure was able to be performed without venous outflow obstruction from either kidney during the creation of both the left gonadal vein and left renal vein anastomosis. To our knowledge, this approach has not been previously performed or described using a robotic approach.
The patient was discharged home on postoperative day one with a normal creatinine, ambulating, and tolerating a regular diet. At follow up, she reported resolution of her preoperative symptoms.
Left renal vein transposition may be performed using a robotic minimally invasive approach while maintaining venous outflow to both kidneys throughout the entirety of the procedure. A dilated gonadal vein identified on preoperative imaging ensures that there is adequate venous outflow during the anastomosis of the left renal vein to the inferior vena cava during the transposition.
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