Laparoscopic nephron sparing surgery on a patient with extreme body deformation due to cerebral palsy. Is this justified when the tumor biopsy is unavailable?

Abdominal surgery on patients with significant body malformation is often a challenge for an operative team. Particularly, when patient presents lesions suspected for malignancy but benign disease cannot be excluded. In the reported case the patient suffered from cerebral palsy and had extreme spinal distortion with significant displacement of internal organs. Solid renal mass was detected incidentally, but because of body deformation the biopsy to asses pathological status could not be performed. The decision to perform surgery was made and the patient underwent successful laparoscopic partial nephrectomy. Pathology examination of the specimen revealed renal cell carcinoma grade 2.