Abstract
Introduction: The incidence of pelvic kidney is 1 in 3000, and therefore the finding of a renal cell carcinoma in a pelvic kidney is exceptionally rare, with very few cases previously described. Laparoscopic nephrectomy represents a surgical approach that is minimally invasive, allowing a faster recovery and reduced hospital stay. Materials and Methods: A 68-year-old man underwent an ultrasound scan, which incidentally revealed a tumor in the pelvic kidney. CT scanning confirmed a 4.8 cm tumor in the left pelvic kidney with no evidence of metastatic disease. A 5.5 cm abdominal aortic aneurysm was also identified. Further analysis of the CT demonstrated the blood supply to be mainly from the left common iliac artery and vein, with an accessory vein passing behind the right common iliac artery, draining into the inferior vena cava. Consideration was given to partial nephrectomy, but given the size of the tumor and potentially unpredictable vascular supply, it was felt best to proceed with laparoscopic nephrectomy. Results: The procedure was carried out successfully with minimal blood loss. The operative time was 125 minutes, and length of stay in the hospital was 3 days. A camera port was positioned just below the umbilicus with two further ports triangulated around the kidney. A fourth port was inserted more laterally for retraction purposes. The challenging aspects of the procedure were in mobilizing the sigmoid colon and dissection of the hilar vessels. Conclusion: To the best of the authors knowledge, this is the first video description of a laparoscopic pelvic nephrectomy. The laparoscopic approach for renal cell carcinoma in a pelvic kidney is a safe and effective means of performing nephrectomy, with the advantages of minimally invasive surgery. Given the extremely variable blood supply, sound preoperative knowledge of the vessels and their origin is important. No competing financial interests exist. Runtime of video: 10 mins 00 secs
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