Teenager Finds Relief from Debilitating Pain with Robotic Surgery

Floating kidney resolved with minimally-invasive nephropexy surgery

Sabrina, age 16, is one of those resilient kids who doesn’t tend to let things bother her. Yet when she started having crushing back pain from a rare, hard to diagnose condition, it was a game changer. The pain sent her to the emergency department 10 times within two months, and stumped doctors.

“She’s tough and it dropped her. She couldn’t do anything. It was so awful to see her in such debilitating pain,” says her mom, Holly.

At first, doctors suspected kidney stones, then appendicitis. Yet imaging studies ruled these out. It was confusing because ultrasounds showed swelling in her kidneys one day, but none the next. Also, some days the pain was manageable and other days all Sabrina could do was lie down and hope medicines would take the edge off.

“It hurt so bad. When I had that pain I couldn’t sit up or walk. I could just lie there crying,” says Sabrina. “I was missing a lot of school.”

Little did doctors know that her right kidney was moving loosely in her abdomen, which can produce intense abdominal/back pain, nausea, and even vomiting. It’s not unusual for “floating kidney”, also called “wandering kidney,” to go undiagnosed for years, leaving people in pain and making it hard to get through the day. Luckily, Daniel Han, MD, a urologist with the nationally-recognized Pediatric Urology program at Stanford Medicine Children’s Health, diagnosed and treated it in less than six months.

Staying the course to find a diagnosis

“Many times, these patients see many doctors and have many tests, but because tests can turn out normal, it goes undiagnosed. They might then simply be prescribed pain medicines and be sent home,” says Dr. Han.

One reason imaging tests miss floating kidney, technically called nephroptosis, is because the kidney can easily change positions—sometimes it’s in the correct spot and other times it’s not when a person stands and gravity pulls it downward.

“We don’t typically give too much thought about the position a patient is in when doing imaging studies,” Dr. Han adds. “That’s one reason this condition is so elusive.”

Despite running test after test for various conditions, everything came back normal, even one for floating kidney. Dr. Han wasn’t willing to give up. He’s thankful that the family stuck with him.

“I felt deeply that there was something going on with Sabrina, and I really wanted to get to the bottom of it. Even though she tested negative for floating kidney, it was in the back of my mind the whole time,” Dr. Han says.

Next, Dr. Han started doing further testing to figure out what was going on. While she was under, Dr. Han also explored her anatomy with an endoscope (a scope with a camera) to watch how injected dye would travel from her ureters (ducts that carry urine), to her kidneys.

“There was no sign of a blockage, but the dye took an unusual route to her right kidney. It did a big turn instead of taking a natural course,” he says.

That’s when he looked at her right ureter with an even smaller camera and noticed that it was opening and closing with breathing near where the ureter attaches to the kidney.

“I don’t think any other doctor in the world would have noticed it,” Holly exclaims, getting emotional. “Things lined up just right for Dr. Han to care for Sabrina.”

During the surgery, Dr. Han placed a stent (small tube) to keep the ureter open and help the kidney drain, hoping it would relieve her pain. If it did, he’d know that it was truly an anatomical problem. The pain improved significantly, even though Sabrina felt the stent itself.

Confirming that it was floating kidney

After the surgery, Dr. Han thought again about floating kidney and he wondered about the accuracy of the first test. That’s when he suggested a two-step surgery to complete another floating kidney test that required placing a nephrostomy tube through her back and into her kidney, observing the results, and taking it out a few months later. But that was too much for the San Carlos, California teenager, and rightly so because it required her to wear a urine drainage bag.

“I don’t think any teenager wants to walk around with a pee bag, so I was against that!” Sabrina exclaims.

“Dr. Han was so accommodating. Sabrina didn’t want to wear the bag even for a week, so he suggested just one day. The whole time he listened to her and made her feel better,” Holly says. “His team arranged all the needed procedures back-to-back in four days, I’m not even sure how.”

Robotic nephropexy surgery saves the day

The plan was to take out the stent and place the nephrostomy tube and urine bag in interventional radiology on day one, complete the floating kidney test and remove the bag on day two, and complete the robotic surgery on day four. The floating kidney test came out negative, but Dr. Han still planned on the robotic surgery to see what he could do to ease her pain.

“When I went in with the robot I could see clearly that it was indeed floating kidney. The kidney was very mobile and moved back and forth freely, so I carefully tacked it up to the muscles in the back of the abdomen to hold it in place,” Dr. Han says.

Sabrina’s nephropexy surgery required Dr. Han to make three, one-third inch incisions and use the robot’s articulating arms and fine motor control to stitch her kidney in place. The da Vinci® robot gives surgeons excellent visualization and allows them to access hard-to-reach areas. It was a complete success.

“Sabrina knows her mind and she is not one to back down. She advocates for herself very well,” Dr. Han says. “And Holly is one of the best parent advocates I’ve ever met. She was both ‘momma bear’ and incredibly thoughtful and pleasant.”

Being minimally-invasive with the robot, the recovery was short and Sabrina went home the next day. Traditional nephropexy surgery is an open surgery that demands a large incision, much more risk, and a long recovery.

Back to being a teen

Sabrina is feeling great these days. She’s free of pain and is eager to get back to volleyball with hopes of someday earning a college scholarship. She just got her first job, and she’s back to school full force.

“It was a huge mystery for a long time, but Dr. Han and his team didn’t give up on her,” Holly says.

Sabrina’s new motto is, ‘Health is wealth.’ It’s made her more positive and appreciative of the little things in life.

“I’m so glad to be myself again. Six months ago, I would not have believed that I could be thriving again,” she says. “I’m so grateful for what I have and for the health care I was able to get.”

The family jokes that they gave her kidney a good test by riding the rollercoasters at Disneyland for four days straight. Next up? Maybe taking Sabrina and her newly-tamed kidney to Paris.