PMC7876737_01
CT abdominal scan with triphasic technique. Imaging revealed an enhancing well-defined heterogeneous large mass measuring originating from the upper pole of the right kidney, with necrotic and solid areas within the lesion.
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Imaging revealed an enhanced well-defined heterogeneous large mass measuring 17 x 15 cm and originating from the upper pole of the right kidney, with necrotic and solid areas within the lesion (Fig. 1).
Details of surgical procedure: a) The patient was placed in left lateral decubitus position with an inclination of 50-60  relative to the operating table; b) trocars position in the right subcostal region; c) details of Kocher's maneuver to access the retroperitoneum; d) right side of the inferior caval vein.
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The patient was placed in left lateral decubitus position with an inclination of 50-60  relative to the operating table which was broken to extend the space between the last rib and the iliac crest and increased surgical field (Fig. 2a). We used a Veress needle to induce pneumoperitoneum and four trocars in the right subcostal region (Fig. 2b). Considering size of lesion the duodenum was medially mobilized (Kocher's maneuver) to access the retroperitoneum on the right side of the caval vein and to reach the adrenal and renal space (Fig. 2c-d) We found a well-capsulated renal mass dislocating ascending colon and liver.
surgical specimen and functional and aesthetic results after surgery.
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The specimen weighed 1650 g and macroscopically was 21 x 12 x 13 cm in size with a smooth capsulated renal mass (Fig. 3).