Open repair of iatrogenic complete aortic occlusion during robotic right nephrectomy: a case report

Vascular injury during nephrectomy is a rare but serious complication. We present a unique case of complete occlusion of the infrarenal aorta following a right-sided robotic nephrectomy. We present a 54-year-old male with no known comorbidities who underwent a right robotic radical nephrectomy with retroperitoneal lymph node dissection for a right renal mass. Postoperatively, the patient developed progressive bilateral lower limb weakness and sensory deficits. Clinical examination revealed absent lower limbs pulses bilaterally, with no Doppler signals. Urgent computed tomography (CT) angiography revealed complete occlusion of the infrarenal. Aortic exploration revealed Hemolok clips clamping the aorta. Arterial occlusions may present with delayed signs and require a high index of suspicion for diagnosis. CT angiography is crucial in guiding management. Prosthetic grafting is the preferred method of repair. Here, we highlight the importance of early recognition and intervention. Prompt surgical revascularization can significantly improve prognosis and recovery.