Open repair of iatrogenic complete aortic occlusion during robotic right nephrectomy: a case report

TL;DR

A rare case of aortic occlusion during robotic kidney surgery is reported, emphasizing the need for early detection and surgical repair to improve recovery.

Contribution

This case report highlights a unique complication of robotic nephrectomy and underscores the importance of prompt diagnosis and intervention.

Findings

Complete occlusion of the infrarenal aorta was caused by Hemolok clips during a robotic nephrectomy.

CT angiography was crucial for diagnosing the occlusion and guiding surgical repair.

Prompt surgical revascularization significantly improved the patient's prognosis.

Abstract

Vascular injury during nephrectomy is a rare but serious complication. We present a unique case of complete occlusion of the infrarenal aorta following a right-sided robotic nephrectomy. We present a 54-year-old male with no known comorbidities who underwent a right robotic radical nephrectomy with retroperitoneal lymph node dissection for a right renal mass. Postoperatively, the patient developed progressive bilateral lower limb weakness and sensory deficits. Clinical examination revealed absent lower limbs pulses bilaterally, with no Doppler signals. Urgent computed tomography (CT) angiography revealed complete occlusion of the infrarenal. Aortic exploration revealed Hemolok clips clamping the aorta. Arterial occlusions may present with delayed signs and require a high index of suspicion for diagnosis. CT angiography is crucial in guiding management. Prosthetic grafting is the preferred method of repair. Here, we highlight the importance of early recognition and intervention. Prompt surgical revascularization can significantly improve prognosis and recovery.

Figures