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

Abstract

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: Minimally invasive surgery; Pediatric urology; Sequestered diverticulectomy; Sequestered diverticulum.