• Both kidneys of the patient were present on the same side, fused together, with tangled arteries, veins, and ureters, adding significant complexity to the removal of the tumor.
• The advanced features offered by the robotic system enabled the surgeons to precisely remove the tumor and successfully preserve one kidney, resulting in better health outcomes.

Doctors at Apollo Multispecialty Hospitals, Kolkata, saved the life of a 60-year-old patient who was suffering from a rare, complicated kidney cancer using robotic-assisted surgery. The surgery was led by Dr. Tarun Jindal, Senior Consultant, Uro Oncology, with the help of the advanced robotic–assisted surgery system, da Vinci. This is the first time a successful surgery being performed in India to remove cancer from crossed-fused ectopic kidney.

Otherwise asymptomatic, the patient had observed a lump on his abdomen before deciding to get medical help. A CT scan showed that he had a rare condition called crossed fusion ectopia – where his left and right kidneys were both on the right side, with the right kidney on top and the abnormal left kidney below it. An 11 cm tumor was also observed arising from the upper kidney. Crossed fusion ectopia occurs in approximately 1 in 10,000 people, making it relatively uncommon, though not extremely rare. However, the development of a tumor in such cases is considered exceptionally rare.

“The main challenge was to save one kidney and its ureter while dealing with the crisscrossing of both ureters and blood vessels. It was crucial to accurately identify the blood supply to the abnormal kidney, pinpoint the correct ureter to preserve, and remove the one involved with the tumour, ensuring precision throughout the procedure. If the blood supply to the abnormal kidney is not correctly identified, it could lead to damage or loss of the healthy part of the kidney, causing further complications. Similarly, if the correct ureter is not preserved, it may impair the kidney’s ability to drain urine properly, leading to infections or kidney failure. Proper identification and precision are critical to ensure the patient’s long-term health and recovery,” said Dr. Tarun Jindal, adding, “We opted for robotic-assisted surgery to carefully preserve the function of the lower kidney, which was less affected by the tumor compared to the upper kidney. This approach was crucial to ensure better health outcomes for the patient and to avoid the need for dialysis.”

An upper polar radical nephrectomy along with the partial nephrectomy (a surgical procedure where only part of the kidney is removed) at the level of the junction of two kidneys was performed using advanced da Vinci technology wherein the tumor-bearing part of the kidney was removed while ensuring that the remaining healthy kidney and ureter were preserved. Technology played an important role in this complex surgical case, enabling a minimally invasive approach that would have been daunting without prior experience and advancements. The integration of ICG (Indocyanine Green) imaging provided real-time insights, helping distinguish between the two kidneys and their boundaries.

“The use of da Vinci robotic platform offered enhanced visualization, allowing me to see tiny blood vessels that would be challenging to detect with the naked eye. This approach significantly reduced the incision size, enabling the patient to be discharged within two days instead of the extended recovery time required for open surgery, which would have involved a large incision. Additionally, blood loss was minimal, eliminating the need for transfusions, which would have been inevitable in an open procedure,” Dr. Tarun Jindal stated.

The 60-year-old patient, expressed his gratitude towards the medical team saying, “I am indebted to the doctors and the entire team for their exceptional care. I was discharged just a few days after the surgery, and today I’m feeling fit and fine. My health has fully improved, with all my tests, including creatinine levels, coming back normal. I’m forever grateful for the expertise and support I received.”

According to Dr. Tarun Jindal, the patient will be able to live a full, healthy life with no major lifestyle changes required. “However, since he now has only one kidney, he should avoid certain drugs and antibiotics as part of his routine to prevent damage to his remaining kidney,” he stated.