Robotic Assisted Calyceal Diverticulectomy
Kyle A. Gillis, MD, Paul Jones, MD, Casey Seideman, MD.
Oregon Health and Science University, Portland, OR, USA.
Objectives: Calyceal diverticulum is a relatively rare phenomenon in children, with only a subset of patients being sufficiently symptomatic to warrant intervention. There is an expanding role of minimally invasive surgery for pediatric patients. We present the surgical management of a boy with calyceal diverticulum who underwent robotic calyceal diverticulectomy
Materials and Methods: Our patient is a 7 year-old male who presented to the ED with abdominal pain. Renal ultrasound and MAG3 showed a large cystic structure in the right kidney. An MR urogram and retrograde pyelogram confirmed calyceal diverticulum. The family elected to undergo a robot assisted laparoscopic calyceal diverticulectomy. The calyceal diverticulum was managed intraoperatively with opening and drainage of the cystic structure, excision of diverticular walls, fulguration of the urothelial bed and exposed renal parenchyma. The tiny collecting system ostium was identified with aid of a previously placed ureteral stent, which permitted retrograde reflux of methylene blue tinged fluid from the bladder into the upper collecting system. The ostium was closed with multiple layers.
Results: The patient recovered uneventfully without urine leak or significant kidney dysfunction. Ureteral stent was removed at 1 month and he being followed with serial ultrasounds.
Conclusions: Multiple imaging modalities are required to diagnose a calyceal diverticulum. Robot assisted laparoscopic calyceal diverticulectomy is a safe and effective way to surgically manage calyceal diverticulum in children. Intraoperatively, it is paramount to utilize multiple maneuvers to help identify the ostium prior to closure.
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