PMC6154395_01
Port arrangement in each operation (: 12 mm trocar,  : 8 mm trocar,  : 5 mm trocar) (a) Case 1 (b) and case 3. (b) Case 2.
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PMC6154395_03_gr1.jpg
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Under general anesthesia, the urologists started the RARP with the patient in the lithotomy position and using six ports, the same arrangement as shown in Fig. 1a.
The examination of imaging before the operation in case 1.. (a) Colonoscopy showed rectal cancer. (b) CT suggested lymph node metastasis (yellow arrow).. (c) MRI showed prostate cancer on the left lobe (white arrow).
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Colonoscopy found rectal adenocarcinoma (Fig. 2a), with evidence of lymph node metastasis on computed tomography (CT, Fig. 2b). Magnetic resonance imaging (MRI) and biopsy revealed prostatic adenocarcinoma (Fig. 2c).
PMC6154395_02
Port arrangement in each operation (: 12 mm trocar,  : 8 mm trocar,  : 5 mm trocar) (a) Case 1 (b) and case 3. (b) Case 2.
gr1.jpg
PMC6154395_03_gr1.jpg
fig0005
Under general anesthesia, the urologists started the RARP with the patient in the lithotomy position and using six ports, the same arrangement as shown in Fig. 1a.
Abdominal CT and endoscopic findings in case 2.. (a) Abdominal CT in outpatient show obstruction of left side transvers colon (yellow arrow).. (b) Left kidney mass was incidentally found, suggested renal cell carcinoma (white arrow).. (c) Colonoscopy showed tumor obstruction.
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PMC6154395_02_gr3.jpg
fig0015
CT revealed obstruction of the left transverse colon (Fig. 3a), cancer of the left kidney (Fig. 3b), and a splenic aneurysm. Colonoscopy confirmed a constricting tumor of the transverse colon (Fig. 3c) pathologically diagnosed as adenocarcinoma.
PMC6154395_03
Port arrangement in each operation (: 12 mm trocar,  : 8 mm trocar,  : 5 mm trocar) (a) Case 1 (b) and case 3. (b) Case 2.
gr1.jpg
PMC6154395_03_gr1.jpg
fig0005
Under general anesthesia, the urologists started the RARP with the patient in the lithotomy position and using six ports, the same arrangement as shown in Fig. 1a.
Abdominal CT findings in case 4.. (a) Preoperative abdominal CT showed peripheral wall irregularities of the descending colon (yellow arrow).. (b) After colonic stent placement, enhanced CT showed metastatic lymph node (white arrow).. (c) Wall irregularities and rearward protrusion of prostate in enhanced CT (yellow circle).
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fig0020
Endocrine therapy was started, and surgery was scheduled, but a preoperative abdominal CT was suspected tumor of the descending colon (Fig. 4a). The diagnosis was synchronous adenocarcinoma of the descending colon and the prostate, both of which were advanced (Fig. 4b, 4c).