Robot-Assisted Laparoscopic Nephropexy for Symptomatic Nephroptosis in a Pediatric Patient: An Abstract from Akron Children’s Hospital Resident and Fellow Academic Day

Nephroptosis, or “floating kidney”, is characterized by downward descent of the kidney (over 5 cm or two vertebrae) when moving from a supine to an upright position. While many cases are asymptomatic, affected individuals can experience an array of symptoms, including abdominal or flank pain, a mobile palpable mass, or recurrent episodes of Dietl’s crisis. Patients may struggle for years prior to diagnosis, as the kidney appears normal on traditional imaging when performed supine. Here, we describe a case of symptomatic nephroptosis in a pediatric patient treated successfully with robotic nephropexy. A 17-year-old female presented with a 2-year history of right upper quadrant (RUQ) abdominal pain associated with a palpable right flank mass. Initial physical exam, abdominal ultrasound, x-ray, and gastrointestinal workup were unremarkable. Repeat renal ultrasound demonstrated descent of the right kidney into the RLQ upon standing, corresponding to the palpable right-sided mass present on physical examination. A diagnosis of right nephroptosis was made, and the patient initially elected for observation without improvement of her symptoms. Thus, robot-assisted laparoscopic nephropexy was performed. The patient was positioned in the lateral decubitus position with the right flank upward. Three 8-mm robotic ports and a 5-mm assistant port were placed in standard configuration for transperitoneal renal surgery. The right kidney was mobilized and dissected entirely free of perirenal fat. Three-point fixation was performed using nonabsorbable (Ethibond 2-0) sutures passed through the lateral surface of the kidney and the adjacent psoas and quadratus lumborum muscles. These were secured with Hemo-o-Lock clips using a sliding-clip technique. The right colon flexure was then attached to the lateral abdominal wall, securing the kidney under the liver. Postoperatively, the patient was placed on bed rest for 24 hours and discharged on postoperative day 2. Renal ultrasound performed 3 months later confirmed the absence of right nephroptosis upon standing, and the patient reported complete resolution of her symptoms.Our case highlights the insidious presentation of symptomatic nephroptosis, which, although rare in pediatric patients, requires a high degree of suspicion. Robot-assisted laparoscopic nephropexy can be safely and effectively performed in pediatric patients presenting with symptomatic nephroptosis.