PMC6796603_01
Abdominal CT showing IVC located at the left side of the Aorta.
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IVC located at the left side of the Aorta, crossing the midline to its right side at the level of the ostium of a single left renal vein in which both adrenal and gonadal veins drained (Fig. 1). In addition, the length of left single renal artery and vein were measured as 3.88 cm and 3.49 cm (vs 2.68 cm in the right side), respectively.
Trocar placement. The hand-assistance device (Gelport ) was placed through a small midline periumbilical surgical wound of 5 cm close to a 10 mm trocar for the optic placement (A). Two additional 5 mm trocars (one placed in the midclavicular line subcostally (B); the other halfway between the umbilicus and the anterior-superior iliac spine (C)), completed the access to the peritoneal cavity.
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After Gelport  and trocar placement (Fig. 2), the abdomen was insufflated to maximally 12 mmHg, showing multiple adhesions extending throughout the abdominal cavity including the left colon, liver, and spleen.
Laparoscopic view of main renal artery and vein isolated before the endovascular stapling. Adrenal and gonadal veins have been dissected and divided using LigaSure  after clip placement. The main renal artery take-off was located posterior to the left-sided IVC.
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The main renal vein was located anterior to the course of the main renal artery, and its take-off was placed posterior to the infrarenal IVC (Fig. 3).
Endoscopic view representation of the left-sided IVC left LDN. The main renal artery and vein were controlled by means of endovascular stapling. Adrenal and gonadal veins draining in the left renal vein were previously divided with LigaSure .
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Both vascular structures were isolated and controlled using an endovascular stapler (Fig. 4).