PMC6167582_01
(a) CT scan axial image. A 28 mm tumor is shown in the right renal pelvis. (b) T2-weighted MR image. Arrow indicates the isthmus of a horseshoe kidney. (c) Diffusion-weighted MR image. The tumor in the right renal pelvis shows high signal.
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Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an atrophic right renal unit and a right renal pelvic tumor of 28 mm, which exhibited high signal intensity on diffusion-weighted MRI (Figure 1).
(a) A wound retractor was placed at the pararectal incision of 6 cm made in the right upper quadrant. (b) Nephroureterectomy was carried out by keeping the retroperitoneal working space made along the anatomical plane using the Omni-Tract retractor system and PLES retractors (an arrow head). Asterisks indicate blades of the Omni-Tract retractor system. (c) Isthmusectomy was conducted using a bipolar sealing device. A vessel loop was passed beneath the isthmus. (d) The right retroperitoneal after completion of right nephroureterectomy and isthmusectomy. A drain tube was placed here after extensive saline irrigation.
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Alexis Wound Retractor (Applied Medical, California, USA) was placed to make a single port of 5.5 cm in diameter (Figure 2(a)), and Omni-Tract FastSystem (Integra, Pennsylvania, USA) and PLES retractors (Innomedics Medical Instruments Inc., Tokyo, Japan) were used to keep an extraperitoneal working space (Figure 2(b)). Isthmusectomy was conducted using Sonicision (Covidien, Minnesota, USA) and LigaSure (Figure 2(c)). The operative field was irrigated with saline of 2L, a drain tube was placed in the right retroperitoneal space (Figure 2(d)), and the wound was closed.
(a) A nodular pedunculated tumor measuring 3.2*2.4*1.0 cm in the right renal pelvis. Inset, magnified image of the tumor. (b) Gross appearance of formalin-fixed tumor section. Surgical margin was negative microscopically.
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Gross appearance of the resected specimen showed a nodular pedunculated tumor measuring 3.2*2.4*1.0 cm in the right renal pelvis (Figure 3).