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Extra Peritoneal Para Aortic Lymphadenectomy in a Horseshoe Kidney
Mikel Gorostidi Pulgar*, Olaia Aristegui, Ane Bombin, Maialen Olazabal, Arantxa Lekuona and Irene Diez
Department of Obstetrics and Gynecology, Hospital Universitario Donostia, San Sebastián, Spain
*Corresponding author: Mikel Gorostidi, Department of Obstetrics and Gynecology, Hospital Universitario Donostia, Spain
Published: 18 Feb, 2018
Cite this article as: Pulgar MG, Aristegui O, Bombin
A, Olazabal M, Lekuona A, Diez
I. Extra Peritoneal Para Aortic
Lymphadenectomy in a Horseshoe
Kidney. Clin Oncol. 2018; 3: 1413.
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A woman with IB endometrial cancer and horseshoe kidney was admitted for surgery in our
department. Pre operative work up was planned with an MRI to detect miometrial invasion and
to caracterice renal anomaly. A laparoscopic extra peritoneal Para-aortic lymphadenectomy was
performed at the beginning of the staging procedure. The procedure was completed with a bilateral
pelvic lymphadenectomy and BSO-TLH (bilateral salpingo oophorectomy-total laparoscopic
hysterectomy).
Ananomalous vascular pattern of this renal fusion anomaly requires careful prior evaluation [1].
There are several anatomical variations and abnormalities in blood supply that can be a challenging
situation [2]. Extra peritoneal approach has the advantage of avoiding dealing with this dangerous
dissection.
Extra peritoneal approach required lifting the left part of the kidney allowing entering below it
and performing a Para-aortic and caval lymph node dissection.
Upper limit of Para-aortic lymphadeneo to my was considered at the point where a major
vessel, 5 cm above the IMA, is visualized coming from the left side of the horseshoe kidney. The
ureter and left gonadal vein was not identified. This upper limit is
reasonable, avoiding the risk of kidney damage and injuries to the
superior mesenteric artery.
Transperitoneal approach requires dealing with all the renal
tissue bellowing frame senteric aorta and cava. Extra peritoneal
paraaortic lympha denec to my is feasible in this cases, allowing to
remove all the nodes in this area, and avoids the inconvenience of the
transperitoneal approach, having the who kidney in them idle of the
surgical field.
A total Para-aortic retroperitoneal dissection is feasible with this
extra peritoneal approach without the inconvenience of renal tissue
in the middle of the surgical field, lifting it up and pushing it away of
the surgical field.
Figure 1
Figure 2
Figure 3
Figure 3
Abnormal left renal vein coming up from vena cava 5 cm above the
IMA, from the left side of the horseshoe kidney. Left kidney pole is visualized
at the roof of the dissection.
References
- Evans CP, Tunuguntla HS, Saffarian AR, Wood CG. Does retroperitoneal lymphadenectomyfor testicular germ cell tumor require a different approach in the presence of horseshoe kidney? J Urol. 2003;169(2):503-6.
- Natsis K, Piagkou M, Skotsimara A, Protogerou V, Tsitouridis I, Skandalakis P. Horseshoe kidney: A review of anatomy and pathology. Surg Radiol Anat. 2014;36(6):517-26.