PMC9640922_01
CTU and CTA show well-defined right renal pelvis mass complicated with horseshoe kidney and hydronephrosis.
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Preoperative imagological examination (Figure 1) demonstrated a right renal pelvis mass with hydronephrosis, horseshoe kidney, and ureteral stent placement in the right urinary tract.
Key steps of the surgery. (A) Retracted the liver cephalad and exposed kidney. (B) Dissociated the ascending colon and duodenum to the midline. (C) Exposed the inferior vena cava. (D) Cut off the first renal artery and vein. (E) Divided the vasa vasorum. (F) Cut off the second renal artery and vein. (G) Fully exposed the isthmus and started slicing. (H) Sutured the left renal isthmus stump. (I) Sutured the bladder and lateral peritoneum.
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We retracted the liver cephalad and incised the lateral peritoneum to expose the kidney ( Figure 2A ), then dissociated the ascending colon and duodenum to the ventral midline ( Figure 2B ). In the next step, we located the ureter and exposed the inferior vena cava behind the right kidney ( Figure 2C ). The fat and the fascia were carefully cleaned until the pulsating renal artery was visualized at the right renal hilum, then inspected and clipped with Hem-0-Lok clips ( Figure 2D ). Figure 2E ), and the second renal artery and vein in the medial inferior part of the right kidney were cut off ( Figure 2F ). Finally, we fully exposed the isthmus and started slicing, using a 2-0 barbed thread to suture while slicing until the isthmus was completely dissected ( Figure 2G ), and then sutured the left renal isthmus stump properly ( Figures 2H, I  ).
Cancer characteristics. (A) Gross appearance of the specimen; the tumor is 4 x 3 x 1.5 cm mass in the transition between the renal pelvis and ureter. (B) The Trocar port is placed during the tumor separation procedure. (C, D) The histopathological findings of the isolated specimen.
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In addition, a 4 x 3 x 1.5 cm mass was seen at the transition of the renal pelvis and ureter ( Figure 3A ). The incision of the trocar healed well, and no intraoperative complications such as infection and bleeding occurred ( Figure 3B ). There was no cancer involvement in the ureter and bladder wall ( Figures 3C, D  ).