Robot-assisted surgery in horseshoe kidneys: A safety and feasibility multi-centre case series

Objective: We assessed the safety and feasibility of minimally invasive robot-assisted surgery for horseshoe kidney (HSK). Method: A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. Results: Seven patients underwent robotic surgery for HSK, comprising three partial nephrectomies for renal masses, one nephroureterectomy and three benign nephrectomies for non-functioning kidneys. The median age was 53 (interquartile range (IQR) = 47-60) years and median body mass index (BMI) was 25 (IQR = 25-26.5). Median console time was 120 (IQR = 118-215) minutes and median estimated blood loss was 150 (IQR = 125-250) mL. The median pre- and post-operative estimated glomerular filtration rate (eGFR) was 76 (IQR = 72-90) and 71 (IQR = 60-81), respectively. There were no higher-grade complications (Clavien-Dindo III-IV) and one Clavien-Dindo grade II complication (wound infection treated with IV antibiotics). Median length of stay (LOS) was 2 days and there were no 30-day readmissions. Negative margins were achieved in 75% of tumour resections. Conclusion: We report one the largest series of robot-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high-volume centres with acceptable perioperative outcomes. Established benefits of minimally invasive surgery, such as reduced LOS and low complication rates, were demonstrated.