PMC3021314_01
2.6 cm mid to lower pole location of enhancing renal tumor (arrow).
jsls-14-1-126-g01.jpg
PMC3021314_01_jsls-14-1-126-g01.jpg
F1
During workup for renal transplantation, a computed tomography (CT) scan revealed an ectopic pelvic left kidney with a 2.6-cm enhancing mass located in the anterior portion of the mid to lower pole (Figure 1).
Separate hilar structures demonstrated with arrows.
jsls-14-1-126-g02.jpg
PMC3021314_01_jsls-14-1-126-g02.jpg
F2
The second originated directly from the aorta and vena cava and entered the kidney from the anterolateral direction (Figure 2).
Location of port sites for left sided pelvic nephrectomy.
jsls-14-1-126-g03.jpg
PMC3021314_01_jsls-14-1-126-g03.jpg
F3
A fourth port was placed laterally to retract the sigmoid colon medially (Figure 3), because it was draped directly over the kidney and difficult to mobilize (Figure 4).
Sigmoid colon (left arrow) and anterior surface of kidney (right arrow) during medial mobilization of sigmoid colon.
jsls-14-1-126-g04.jpg
PMC3021314_01_jsls-14-1-126-g04.jpg
F4
A fourth port was placed laterally to retract the sigmoid colon medially (Figure 3), because it was draped directly over the kidney and difficult to mobilize (Figure 4).
Difficulty encountered visualizing first set of hilar vessels (middle arrow), due to sigmoid colon (left arrow). Renal tumor visualized (right arrow).
jsls-14-1-126-g05.jpg
PMC3021314_01_jsls-14-1-126-g05.jpg
F5
Therefore, dissection was carried in a caudal direction starting at the upper pole, which then uncovered these hilar vessels that were draped over the ipsilateral common iliac artery (Figure 5).
Second set of hilar vessels visualized (right arrow) with sigmoid colon in proximity (left arrow).
jsls-14-1-126-g06.jpg
PMC3021314_01_jsls-14-1-126-g06.jpg
F6
At the level of the upper pole, the second set of hilar vessels were identified and individually divided with the endovascular stapler (Figure 6).