Technical considerations for laparoscopic right renal surgery in presence of Riedel's lobe of the liver.

Riedel's lobe of the liver is an anatomic variant, described as a caudal extension of the right lobe of the liver, that presents a challenge in laparoscopic right renal surgery. A 52-year-old woman with a Riedel's lobe of the liver and a large right renal mass underwent laparoscopic right radical nephrectomy. Transperitoneal access with the Veress needle through a right lateral port was initially unsuccessful. After a supraumbilical approach, pneumoperitoneum was eventually achieved. The right lateral liver attachments were freed, and the lobe was retracted medially to expose the right kidney and its hilum. The surgery was then performed successfully. Riedel's lobe presents two special technical concerns: intraperitoneal access and hilar exposure. For access, an initial supraumbilical approach, or possibly an open approach, decreases the risk of liver injury. For renal and hilar exposure, the right lateral liver attachments can be taken down so that the hepatic lobe can be retracted medially instead of in the conventional cephalad direction. Retroperitoneal access, if feasible, may also circumvent these problems. Surgery can then be performed safely and effectively.