#337 Horseshoe Kidney Donor Nephrectomy : Possible with ICG-Drs. K. Guleria & Anant Kumar

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans at the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Horseshoe Kidney Donor Nephrectomy : Possible with ICG Dr Anant Kumar, Dr Karandeep Guleria, Dr Samit Chaturvedi Max Superspeciality Hospital, Saket, New Delhi Abstract:

INTRODUCTION: The Horseshoe kidney is an anatomical complexity of nature leading to difficult handling and procedural complexity for surgeons. The use of a horseshoe kidney as donor in renal transplant remains controversial, although cases have been performed via open and laparoscopic techniques in the past. Anatomical and structural variation in HSK makes it difficult for live kidney donation surgery via conventional approaches. Robotic-assisted surgery has expanding indications in the field of Urology and has been used in past for various other surgeries in HSK patients.

CASE REPORT: Here we report the first case in the literature of robot-assisted donor nephrectomy in a female with a horseshoe kidney. A 49 year female underwent right moiety donor nephrectomy. The right kidney is supplied by a main renal artery and branches of a common lower polar artery. The left kidney is supplied by two large caliber main renal arteries and a thin caliber accessory renal artery. One common lower polar renal artery is seen arising from the anterior aspect of distal aorta supplying bilateral lower poles and isthmus. Level of demarcation over the thick isthmus was noted by intravenous ICG (indocyanine green dye) infusion. The intraoperative and post-op period was uneventful and patient was discharged on POD 4. 

Conclusion: Transplantation of horseshoe kidneys remains technically challenging specially with minimal invasive approach. Here we used the Firefly technology and I/V ICG to our advantage to complete this complex procedure.

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