A 77-year-old female body was received through the Saint Louis University Gift of Body Program of the Center for Anatomical Science and Education (CASE) with a signed informed consent form from the donor. The CASE gift body program abides by all the rules set forth by the Uniform Anatomical Gift Act (UAGA).\nDuring routine dissection, the hilum of the left kidney was cleaned and typical anatomical structures were identified, from anterior to posterior, as the renal vein, renal artery, and superior ureteral contribution (Figures and ). Following the removal of perirenal fat, a second ureteral contribution was found exiting the kidney, slightly inferior to the hilum. The two independent contributions, superior and inferior, descended 12.4 cm and 10.6 cm before they united anterior to the left psoas major muscle to descend over the left common iliac artery to the posterolateral aspect of the bladder ().\nFurther dissection revealed an additional vascular structure, the left aberrant renal artery, entering the inferior pole of the left kidney (). Cleaning the structure revealed its origin from the abdominal aorta 4 cm inferior to the left renal artery, which branched from the aorta below the superior mesenteric artery. The aberrant renal artery was then observed travelling in parallel with, but inferior to, the left renal vein and artery toward the left kidney. This artery was also observed passing anterior to the superior and inferior ureteral contributions and bifurcated just prior to reaching the parenchyma of the inferior renal pole of the left kidney. The left ovarian artery was observed branching from the aberrant renal artery nearly halfway to the left kidney. The left ovarian artery then descended medially, but adjacent to the superior ureteral contribution, and more inferiorly, adjacent to the united ureter to supply the left ovary ().
A 51-year-old female had palpitations and radiating back pain and underwent whole-aorta angio 3D computed tomography (CT). The CT revealed a horizontal axis right kidney with a 4.2 cm, lobulating contour multilocular cystic mass at the lower pole. There were multiple irregular, enhancing septations with an enhancing solid portion and central calcification in the mass. The renal artery was located ventrally and the renal vein was located dorsally. The renal pelvis was located caudal to the renal vessels (). She was diagnosed as having cystic RCC in the horizontal axis right kidney and underwent hand-assisted laparoscopic radical nephrectomy in September 2010.\nUnder general anesthesia, the patient was positioned in the left lateral decubitus position. A 7 cm laparoscopic hand-assist device was placed in the right lower quadrant with the placement of two additional 10 mm ports directly cephalad along the lateral rectus border, allowing 8 cm of separation between the ports and the hand-assist device. Following dissection into the retroperitoneal space, the kidney was separated from the psoas muscle, adjacent bowel, and liver. There was a 4 cm cystic mass in the horizontal axis right kidney (). The ureter was carefully isolated and divided. The renal artery and renal vein were adhered together, so we used an Endo-GIA universal stapler (Covidien Surgical, Dublin, Ireland) and divided them, thereby isolating the entire right kidney. The specimen was entrapped in a laparoscopic sac and extracted. The procedure was completed successfully with a surgical time of 1 hour and an estimated blood loss of 100 ml. Patient-controlled analgesia with morphine was discontinued on postoperative day one. Postoperatively, the patient did not develop any complications. Pathology revealed the tumor to be a clear cell carcinoma (Fuhrman grade 3) with the tumor limited to the kidney (T1a) and with negative resection margins. In December 2010, follow-on CT revealed no recurrence of the disease.