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Treatment of Posterior Left Renal Vein Compression with Robotic-Assisted Laparoscopic Technique
Brian J. Jones
1, Nabeeha Khan
2,
Ryan P. Werntz1
1Prisma Health - Upstate, Greenville, SC;2University of South Carolina School of Medicine - Greenville, Greenville, SC
BACKGROUND: Left renal vein (LRV) compression syndrome—commonly referred to as renal nutcracker syndrome (RNS)—is characterized by compression of the LRV between the aorta and either the superior mesenteric artery (anterior type) or the vertebral body (posterior type). Both anterior and posterior RNS pose significant diagnostic and therapeutic challenges. While robotic-assisted laparoscopic techniques have advanced over the past decade for anterior LRV transposition, open surgical transposition remains the standard approach for posterior RNS.
METHODS: We describe a case of robotic-assisted laparoscopic LRV transposition in a 27-year-old woman with posterior RNS, presenting with a history of recurrent flank pain, hematuria, and postural orthostatic tachycardia.
RESULTS: The patient underwent the procedure without complications and was discharged the following day with resolution of her symptoms. The only perioperative issue noted was moderate left lower abdominal and hip edema, which resolved within three days following the use of maternity-style compressive stockings. At her one-year postoperative evaluation, she remained asymptomatic with maintained LRV patency.
CONCLUSIONS: To our knowledge, this is the first reported case of robotic-assisted laparoscopic LRV transposition for the treatment of posterior RNS. This case highlights the safety and efficacy of minimally invasive techniques for vascular conditions traditionally managed with open surgery and contributes to the growing body of evidence supporting robotic-assisted approaches as a primary treatment modality for all forms of RNS.
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