College Skier Undergoes First-of-its-Kind Surgery for Vein Compression Syndrome

As a lifelong, competitive cross-country skier, University of Denver senior Sidney Barbier is no stranger to pain.

To participate in the Nordic 10- and 20-kilometer events, in which Sidney specializes, requires developing powerful arm, leg and core muscles, as participants must propel themselves up and down inclines in a shuffling or gliding motion.

With 10 to 20 hours of intense cardiovascular exercise and training each week, year-round, the sport can take a toll on joints and ligaments throughout the body. Sidney takes pride in overcoming the pain and fatigue, relying on her steely determination to soldier on toward the finish line.

“It’s really a lot of strain on your body, physically and aerobically,” says the 21-year-old Colorado native, who is an environmental science and music major and accomplished violist. “But I’m stubborn and would keep pushing myself.”

When Sidney didn’t enter, or was unable to complete, several races for the University of Denver Pioneers during the 2023-24 season due to searing pain in her left side, back and abdomen, it was apparent her years-long struggle with a physical condition was far from over.

Sidney had undergone countless colonoscopies and other diagnostic tests since her symptoms began as a young teenager. She was given a multitude of different diagnoses for the periodic and debilitating pain including her diet, hormonal deficiencies, gastrointestinal issues, gynecological problems or anxiety, among others. None of the suggested treatments worked, not even the removal of her gall bladder.

Desperate for answers after her nearly five years of managing health issues, Sidney scheduled a consultation with several specialists in gastroenterology, endocrinology and urology at Cleveland Clinic in early 2024.

During one of the exams, Sidney mentioned a physician in Denver had suspected she was suffering from left renal vein entrapment syndrome, also known as nutcracker syndrome, a condition in which the vein carrying blood to a kidney is misaligned and squeezed by two other blood vessels. But because it is a rare condition, and Sidney did not experience blood in her urine, the physician thought nutcracker syndrome was unlikely.

Sidney’s Cleveland Clinic urologist consulted with urologic surgeon, Mohamed Eltemamy, MD, who quickly determined Sidney did have nutcracker syndrome.

Dr. Eltemamy is not surprised Sidney’s condition had been difficult to diagnose given typical symptoms, including abdominal and flank pain and blood in the urine, are more often caused by other diseases.

“Sidney’s situation was not a classic, straightforward, black-and-white case. Unfortunately, that made her journey much longer,” says Dr. Eltemamy.

Because the compressed left renal vein has no adverse effect on the kidney and only causes occasional pain in most patients, Dr. Eltemamy initially recommended they take a watch-and-wait approach with Sidney’s condition. “Nutcracker syndrome is not life threatening, but surgery is an option to improve the quality of the patient’s life. It just depends on the severity of the pain.”

Sidney’s pain continued to worsen. In March 2024, she returned to Cleveland Clinic to undergo renal vein transposition surgery, which Dr. Eltemamy performed. By moving the left renal vein to a lower position in the abdomen, it would then avoid being compressed by the other blood vessels.

Traditionally, the surgery requires making a large, open incision across the abdomen, which requires many weeks of recovery. In recent years, Cleveland Clinic surgeons have been performing most renal vein transpositions laparoscopically and aided by a multi-port robot.

In Sidney’s case, she became the first person in the world to undergo a single-port robotic renal vein transposition. Dr. Eltemamy says this minimally invasive procedure is an alternative to open surgery.

“The main benefit, first and foremost, is for the patient. Rather than having a larger, midline, incision that goes down your belly, we can make a very small incision – only about 3 centimeters – to insert the robot. The tiny scar is hidden behind the bikini line.”

Importantly, given many patients with nutcracker syndrome have been dealing with severe pain for years, the precise robotic technique enables the surgeon to intricately replicate what would be done during open surgery but with significantly shorter recovery time for the patient.

Dr. Eltemamy and team performed a successful 6 ½-hour procedure in which he guided the single robotic arm that simultaneously accommodated both the necessary surgical instruments and a flexible high-definition camera.

“The surgery really wasn’t too bad, and I went home after one night in the hospital,” marvels Sidney. “Over the summer, I was able to train again, which was really cool. It was kind of scary at first, but after a while I realized I’m feeling better! I don’t have to use a heating blanket to get to sleep anymore.”

Sidney was able to compete again during the 2024-25 season. Now, her sights are set on graduate school, focusing on environmental science, and applying to top schools in the U.S., Canada and France with proximity to snow so she can also still enjoy her favorite sport recreationally.

“The biggest thing is to trust yourself and know you’re not crazy. Your pain is real!” she says, citing the emotional support of her mom, Anne Barbier, through dozens of medical visits and procedures. “Keep the faith you’ll find a doctor, like Dr. Eltemamy and the others I saw at Cleveland Clinic, who will listen to you.”