Nephroureterectomy with En Bloc Sigmoid Resection for Obstructive Colonic Adenocarcinoma After Bilateral Ureterosigmoidostomy with Natural Orifice Extraction
Jeremy Slawin, MD,1 Jose Ortiz de Elguea, MD,2 Roberto Secchi del Rio, MD,2 Kelvin Lim, BS,1 Alex Mackay, MD,1 Raj Satkunasivam, MD,1 and Eric Haas, MD2
1Department of Urology, Houston Methodist Hospital, Houston, Texas, USA.
2Department of Colorectal Surgery, Houston Methodist Hospital, Houston, Texas, USA.
Clinical History: A 41-year-old man with history of bladder exstrophy managed with cystectomy and ureterosigmoidostomy developed left flank pain. Work-up revealed severe left-sided hydroureteronephrosis and accompanying atrophic left kidney caused by an obstructing sigmoid colonic mass at the left ureteral orifice. Colonoscopy and biopsy revealed adenocarcinoma and staging imaging confirmed localized cancer. The patient elected to undergo a robotic left nephroureterectomy with en bloc sigmoid resection.
Intervention: The patient was positioned in a right lateral decubitus position with ports placed as depicted in the accompanying video. A left nephrectomy was performed in the standard manner with the ureter left intact and dissected freely down to its insertion point into the sigmoid colon. The patient was repositioned into low lithotomy and steep Trendelenburg to perform an en bloc sigmoid colon resection. Flexible sigmoidoscopy and preoperative right ureteral stent placement were utilized to ensure the right ureteral orifice was excluded from the colonic resection. A Natural orifice-assisted IntraCorporeal anastomosis with transrectal Extraction of specimen (NICE) procedure was performed to extract the specimen transrectally and restore bowel continuity. To our knowledge, this is the first transrectally extracted kidney specimen reported in the literature.
Follow-up/outcomes: Postoperatively the patient had a routine course, meeting discharge milestones by postoperative day 2. He was seen in the clinic at 2 and 4 weeks postoperatively and was noted to be functioning at his baseline with excellent continence.
Patient Consent: Consent was obtained from the patient to publish this video.
http://online.liebertpub.com/doi/full/10.1089/vid.2022.0040
Robot-Assisted Excision of Perinephric Hydatid Cyst Masquerading As Ruptured Renal Hydatid
Ankit Misra, MCh, Abhay Kumar G, MCh, Uday Pratap Singh, MCh, Sanjoy Sureka, MCh, and Sumit Mandal, MCh
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Clinical History: A 35-year man presented with left flank pain of 6 months and left lower chest pain since 3 months associated with dry cough.
Physical Examination: On examination there was no palpable mass in the abdomen.
Diagnosis: Ultrasonography of the abdomen showed a 9 cm cystic lesion in the upper pole of the left kidney. MRI showed a cystic lesion in the upper pole of the left kidney with internal floating membrane and suspected ruptured hydatid cyst into the perinephric space. Left pleural effusion and perinephric fat stranding were evident on CT of the thorax.
Intervention: Surgery with da Vinci-Xi was planned. With the patient in right lateral position, pneumoperitoneum was created and 8 mm metallic ports were placed in the paramedian line and 12 mm assistant port was placed near the umbilicus on the right of the midline. Palanivelu hydatid trocar-cannula system was used to suction the cyst contents and irrigate it with scolicidal agents.1 The cyst was found to be intact and outside the renal capsule. It was carefully excised and extracted using an endobag.
Outcomes: The docking time was 12 minutes and the console time was 185 minutes. The estimated blood loss was 40 mL. Oral feeds were resumed on postoperative day 1. Pain score was 2 on visual analog scale on day 0. Patient was discharged on day 2 after drain removal. Perinephric hydatid is a rare disease and its management by robot assistance is not published in the literature till date.
Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.
http://online.liebertpub.com/doi/full/10.1089/vid.2022.0050
Reference
1. Kumar S, Pandya S, Agrawal S, Lal A. Laparoscopic management of genitourinary hydatid cyst disease. J Endourol 2008;22:1709–1714.
