PMC7786393_01
Pre-operative pyeloureterography demonstrating right-side mid-ureteral stricture at the level of the sacro-iliac joint.
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F1
Figure 1 presents a later antegrade ureterography showing a patent proximal half of the right ureter with no contrast in the distal half of the ureter, indicating stenosis.
Trocar positioning using the Da Vinci Xi system. (A,B) Nephrectomy phase: patient positioned in modified flank position; four 8 mm robotic trocars in right hemi-abdomen, AirSeal  (ConMed Corp, Utica, NY, USA) trocar as assistant trocar infra-umbilical and a 5 mm subxyphoid assistant port for liver retraction. (C,D) Transplantation phase: The two lowest 8 mm robotic trocars in the right hemi-abdomen are reused. A robotic trocar is placed inside the AirSeal  trocar (port-in-port, not on photo) and an additional 8 mm robotic trocar is placed in the left lower abdomen. A 12 mm subcostal assistant trocar is placed, reusing a former robot trocar site. The most cranial robotic trocar and 5 mm port are no longer used.
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F3
Other trocars were inserted under direct vision as displayed in Figure 3: three additional 8 mm robotic ports, 1 assistant 12 mm AirSeal  (ConMed Corp, Utica, NY, USA) port in the umbilicus, and one 5 mm assistant port subxyphoideal for liver retraction. One additional robot port was placed in the left fossa, a robot port was put inside the 12 mm assistant port at the umbilicus (port-in-port), and the robot port (arm 3 in nephrectomy phase) was changed for a 12 mm assistant port (Figure 3).
Final result.
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F4
An abdominal drain was left in the pelvis (Figure 4).
(A) Pre-operative dimercaptosuccinic acid (DMSA) renal scintigraphy showing a relative right kidney function of 43%. (B) Postoperative DMSA renal scintigraphy after 7 months, showing a relative autotransplant kidney function of 42%. (C) Postoperative duplex ultrasound of the autotransplant, demonstrating adequate perfusion with a resistance index of 0.730.
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F5
Doppler ultrasound of the transplant kidney immediately postoperative demonstrated a resistance index of 0.73, indicating adequate perfusion (Figure 5). However, at 7 months postoperatively, DTPA and DMSA renal scintigraphy demonstrated an absolute total kidney function of 60 mL/min and a relative autotransplant function of 42%, resulting in an absolute autotransplant function of 25.2 mL/min (non-significant drop of -6.7% compared to baseline, Figure 5).