PMC6317102_01
T2-weighted coronal MRI image demonstrating a 6.2x6.3 cm in size, solid mass at the lower pole of the right kidney (1), a 2.4 cm solid mass at the upper pole of the right kidney (2), and a 5.4x4.5 cm in size, solid mass at the lower pole of the left kidney (3).
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Preoperative Magnetic Resonance Imaging (MRI) demonstrated the followings: (1) a 6.2x6.3 cm in size, solid mass at the lower pole of the right kidney, (2) a 2.4 cm solid mass at the upper pole of the right kidney, and (3) a 5.4x4.5 cm in size, solid mass at the lower pole of the left kidney (Figure 1).
Intraoperative photo from the transperitoneal laparoscopic left PN demonstrating the occluded left renal artery using Rummel Tourniquet technique.
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Standard operative technique in our department involves the application of warm ischemia (WI), by using a 2 mm, 30 cm vessel loop, a 2 cm cylinder sheath prepared from a 16 Fr Levin tube, and a large Hem-o-Lok clip (Rummel Tourniquet technique) in order to occlude renal artery (Figure 2).
Postoperative photo demonstrating the surgical specimen of the left laparoscopic PN.
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Histology revealed clear-cell RCC, 5 cm in size, Fuhrman nuclear grade 3, and negative surgical margins (pT1b) (Figure 3).
Intraoperative photo demonstrating manual compression of the renal parenchyma during the resection of the right renal tumor of the lower pole.
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We did not apply any kind of ischemia in order to preserve renal function, but we just applied manual compression at the resection edges periodically in order to facilitate tumors' removal and completion of renorrhaphy (Figure 4).