Laparoscopic partial nephrectomy for the horseshoe kidney with indocyanine green fluorescence guidance under the modified supine position

Introduction: Owing to the complexity of their blood supply, renal tumors in horseshoe kidneys are sometimes technically challenging to resect through laparoscopic procedures.

Case presentation: A 75-year-old man presented with a 3-cm lower-pole mass in the right moiety of the horseshoe kidney. Indocyanine green administration allowed for the identification of the tumor's feeding artery, which was selectively clamped to perform laparoscopic partial nephrectomy. During the procedure, the patient was positioned in the modified supine position (30° semi-lateral position), which enabled us to approach the branch of the left renal artery. Postoperative pathologic examination of the resected mass confirmed the diagnosis of pT1a clear cell renal cell carcinoma with negative surgical margins.

Conclusion: Our novel laparoscopic approach with indocyanine green fluorescence in the modified supine position facilitates the identification of and access to the tumor's feeding artery. This technique is advantageous for laparoscopic partial nephrectomy in patients with horseshoe kidney.