Cancer - Kidney(비디오) (V-006) 로봇 좌측 부분 신장절제술 및 우측 신우요관절제술과 협부절제술 : 마제신에서의 요로상피암 가톨릭대학교 의과대학 비뇨기과학교실 허경재, 문형우, 권혁재, 신동호, 성재우, 박용현, 배웅진, 조혁진, 하유신, 이지열, 김세웅, 홍성후 Introduction Horseshoe kidney is one of the most common congenital renal fusion anomalies, present in the population at a rate of 0.15–0.25%. Because horseshoe kidney merges malformations and vascular changes with difficult approaches, open surgery is the standard for treatment. We describe for the successful performance of robot assisted left heminephrectomy and right nephroureterectomy with isthmectomy in a horseshoe kidney with transitional cell carcinoma. Case presentation In March 2020, a 65-year-old male patient was referred to our hospital. The patient had abdominal pain, and abdominal CT scan revealed 8.6 x 5.5 x 5.1 cm sized heterogeneously enhancing mass with calcifications in the isthmic portion and both side of horseshoe kidney. Renal biopsy was performed to differentiate between renal cell carcinoma and urothelial cell carcinoma. Pathologic results revealed infiltrating urothelial carcinoma, high grade with squamous differentiation. Operation procedure Under general anesthesia, conventional lateral position was made. The camera port was placed on the umbilicus, and two 8-mm trocars were inserted on the midclavicular line in pararectus line. 12mm assist port was placed at the caudal side of the operator's 1st robot trocar. After port was placed, robot (da Vinci Xi ®) docking was done. We performed heminephrectomy of left kidney, first. Adhesions between the kidney capsule, surrounding renal fat and bowel were strong. Left renal mass margin was confirmed by intraoperative ultrasonography. After mass resection, continuous running renorrhapy was done using V-loc. After position change to contralateral side, nephroureterectomy was started. The right renal artery was clamped with hemolock and metal clip. When ureterectomy was done to ureterovesical junction, patient was change to trandelenberg position and head-down was done. Bladder cuff suture was performed using V-loc, and bladder filling up to 150cc of saline revealed no urine leakage. Results Total operation time was 305 minutes (mins). Console time was 172 mins. Warm ischemia time during partial nephrectomy was 18 min 23sec, and the estimated blood loss was 500ml. No perioperative blood transfusion was needed. Conclusion Robot assisted left partial nephrectomy & right nephroureterectomy with isthmectomy was performed successfully with favorable perioperative outcomes. keywords : horseshoe kidney, left partial nephrectomy, right nephroureterectomy