PMC4996612_01
Anterograde pyelography shows a severe ureteral stenosis and continuously about 4 cm of filling defect on the distal side (left). Close-up view of the stenosis site and ureteral polyps with flexible ureteroscope (center/right side).
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Under a flexible ureterorenoscope, multiple polyps measuring about 4 cm in length and the ureteral stenosis on the cephalic side were confirmed continuously (Fig. 1).
It shows positions of the patient and the positions of trocars. : camera port (12 mm),  : left hand for operator (7 mm), : right hand for operator (7 mm),  : 7 mm port for assistant. Flexible ureteroscope was inserted in a right-sided position.
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We used 12-mm camera ports and three 7-mm ports for the left and right hands and an assistant (Fig. 2).
Intraoperative laparoscopic view: The light guide of ureteroscope can confirm from the ureter (top left); multiple polyps bulge out through ureteral incision (top right); arrow indicates anastomosis on posterior wall of the ureter (bottom left); ureteral stent inserted through the urethra easily (bottom right).
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Simultaneously, the site of resection was decided using a laparoscope, regarding the ureteroscope's light guide as a mark (Fig. 3, top left). The length of the ureter to be resected was ~3.5 cm (Fig. 3, top right). Using a 4-0 monofilament, knotted suture was conducted (Fig. 3, bottom left). A 6F Double-J stent was transurethrally inserted (Fig. 3, bottom right).
Intravenous urography showing left renal pelvis to lower ureter at 3 months after the operation (arrow heads).
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At 3 months after the procedure, intravenous urography showed no obstruction and the renal pelvis to lower ureter clearly (Fig. 4).