First single-port robotic renal vein transposition surgery treats nutcracker syndrome

Editor's Note

Sidney Barbier, a University of Denver senior and competitive cross-country skier, became the first person worldwide to undergo single-port robotic renal vein transposition, marking a breakthrough in treating nutcracker syndrome, The Cleveland Clinic reported April 3.

As detailed in the article, the robotic surgery ended a competitive skier’s years-long battle with debilitating pain. Her health challenges began as a teenager with persistent left-side, back, and abdominal pain. She underwent numerous tests and treatments without success, enduring incorrect diagnoses ranging from gastrointestinal and hormonal issues to anxiety. After years of searching for answers, Barbier consulted specialists at Cleveland Clinic, where urologic surgeon Dr Mohamed Eltemamy identified her condition as left renal vein entrapment syndrome, commonly known as nutcracker syndrome. The rare disorder occurs when the left renal vein becomes compressed between other blood vessels, leading to pain and sometimes blood in the urine.

According to Dr Eltemamy, diagnosing nutcracker syndrome can be challenging due to its uncommon presentation and overlapping symptoms with more prevalent conditions. Initially, the surgical team opted for a watch-and-wait approach since the condition is not life-threatening. However, Barbier’s pain intensified, prompting the decision to proceed with renal vein transposition surgery.

Cleveland Clinic’s team performed the procedure using a single-port robotic technique, making a small, three-centimeter incision near the bikini line to insert a single robotic arm, which handled both surgical tools and a high-definition camera. Dr Eltemamy emphasized the patient benefit of avoiding a traditional large abdominal incision, which typically requires extensive recovery. Instead, Barbier was discharged after just one night and resumed training within months.