PMC9807340_01
Computed tomography images at the initial visit (a-c) and after two courses of neoadjuvant chemotherapy (d-f). After neoadjuvant chemotherapy, the right ureteral cancer progressed (b, e; white broken circle) and a right hydronephrosis appeared (d; white arrow).
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Computed tomography (CT) of the chest and abdomen showed no evidence of systemic metastasis, but there were findings suspicious of right ureteral cancer (Fig. 1a). At the end of the second course, a CT scan showed the appearance of right hydronephrosis and progression of the right ureteral cancer (Fig. 1b).
Port placement for RANU (a) and RARC (b). The squares indicate 12-mm ports. The circles indicate 5-mm assistant ports. The triangles indicate the robotic ports (8-mm). Cross marks indicate port holes that were not used in RARC. The combination of squares and triangles indicate port-in-port (8-mm robotic port in 12-mm port).
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Figure 2a shows the trocar arrangement for RANU. Figure 2b shows the trocar arrangement for RARC.
Photographs taken during the surgery: RANU was performed in the left lateral decubitus position (a), followed by RARC in the lithotomy-Trendelenburg position (b).
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Intraoperative port placement is shown in Figure 3.
Abdominal wound findings immediately after surgery: the white arrow indicates the umbilicus. The white arrowhead indicates the ureterocutaneous fistula. The broken white line indicates where the 12-mm port was located, with the skin incision extended to about 5 cm for specimen removal.
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The specimens were removed through a 12-mm port with skin incisions extended to about 5 cm, and three silicone drains were placed (Fig. 4).