Advertisement

Robot-assisted laparoscopic unroofing and fulguration of sequestered caliceal diverticula cluster

      Summary

      Introduction

      We report a rare case of four sequestered caliceal diverticula that failed previous percutaneous sclerotherapy and were subsequently managed with robot-assisted laparoscopic unroofing and fulguration of the sequestered diverticula cluster.

      Methods

      A 6 year-old female was admitted for urosepsis and flank pain. At age 2, a previous institution diagnosed a caliceal diverticulum. Prolonged-delayed magnetic resonance urography confirmed four sequestered caliceal diverticula. Intraoperative ultrasonography identified the diverticula cluster and ensured decompression. The defects were closed after ablating the blood supply, unroofing and decompressing the diverticula, and fulgurating the caliceal lining.

      Results

      Console time was 4 h with an estimated blood loss of 30–50 cc. The patient was discharged post-op day 3. Follow-up renal ultrasound at 6 weeks and 5 months demonstrated progressive atrophy of the left upper pole with preservation of the lower pole size and perfusion. At 9 months, the patient is free of symptoms and urinary tract infections.

      Conclusion

      Closure of unroofed and fulgurated diverticula may be considered when diverticula are anatomically sequestered from the renal collecting system. Robotic-assisted laparoscopic unroofing and fulguration is a technically feasible approach for treatment of sequestered caliceal diverticula in pediatric patients. Additional studies and monitoring of long-term renal function are required.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Waingankar N.
        • Hayek S.
        • Smith A.D.
        • Okeke Z.
        Calyceal diverticula: a comprehensive review.
        Rev Urol. 2014; 16: 29-43
        • Long C.J.
        • Weiss D.A.
        • Kolon T.F.
        • Srinivasan A.K.
        • Shukla A.R.
        Pediatric calyceal diverticulum treatment: an experience with endoscopic and laparoscopic approaches.
        J Pediatr Urol. 2015; 11https://doi.org/10.1016/j.jpurol.2015.04.013