Laparoscopic Partial Nephrectomy with Lap Assisted PCNL in A Patient with Left Mid Pole Tumour with Lower Pole Calculus

Background

A 32 year old male patient presented with left loin pain of 6 months duration.

Diagnosis And Treatment:

On evaluation by CT Urogram there was 3.1 x 2.5x 2.8 cm lesion in the mid pole of left kidney and a 1.9 cm lower pole calculus in left kidney. Metastatic workup was negative. Laparoscopic partial nephrectomy for left mid pole tumour was done. As the stone was in lower calyx, laparoscopic assisted left PCNL was done after the partial nephrectomy in the same sitting. Postoperative period was uneventful. Renal mass histopathology revealed clear cell renal cell carcinoma with Fuhrman grade II with negative resection margin. Patient in follow up since 6 months and is doing well.

Laparoscopy Assisted PCNL (Percutaneous Nephrolithotomy)

Specimen

Discussion

The minimally invasive partial nephrectomy by laparoscopic or robotic method is an established treatment for small renal masses. The treatment of calculi and tumour in the same kidney is complex. The management depends on the location and size of the renal mass and renal calculi. The calculus is removed from the calyx at the partial nephrectomy site. To our knowledge, this is the first case of simultaneous laparoscopic partial nephrectomy and lap assisted PCNL for tumour located in mid pole and stone in lower pole.

About Author –

Dr. V. Surya Prakash ,Consultant Urologist, Laparoscopic, Robotic & Transplant Surgeon

MS (Gen Surgery), FRCSED, M.Ch(Urology), DNB(Urology), D.Lap