PMC4732996_01
Skin metastatic lesions. The skin metastases are seen in the perineum and extend widely to involve the scrotum, penis, and lower abdomen, including the suprapubic area. The patient's penis is curved, with sclerosed foreskin because of multiple tumors.
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fig1
After these operations, the patient's skin metastases extended widely to his perineum, scrotum, penis, and lower abdomen (Fig. 1).
Left, the sites of trocar placement are limited by the skin tumors; the first trocar for the camera is placed in the anterior axillary line at the level of the navel (double circle). The second trocar is placed 5 cm inferior to the first trocar (filled circle). The third trocar (5 mm) is placed 5 cm medial to the first trocar (filled triangle). The fourth trocar is placed 5 cm inferior to the third port (filled square). Right cutaneous ureterostomy and suction drain placement. The ureter is withdrawn through the third port. The ureteral stoma is made using the Toyoda method with a ureteral stent. A 5-mm suction drain is placed through the fourth port and the wounds closed.
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After the retroperitoneal space was extended using a dissecting balloon, a second 5-mm trocar was inserted 5 cm inferior to the first, a third 5-mm trocar was placed 5 cm medial to the first, and the fourth trocar was inserted 5 cm inferior to the third (Fig. 2, left). A 5-mm suction drain was placed through the fourth port, and the wounds were closed with subcuticular sutures (Fig. 2, right).