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.
A 73-year-old man presented with macroscopic hematuria. A pT1 g3 urothelial carcinoma was diagnosed at initial histology, while a re-TUR Bladder confirmed it. Preoperatively, an ectopic pelvic left kidney was reported. A BCG regimen was started and after 2 years a muscle-invasive bladder carcinoma was diagnosed. Staging CT showed no metastatic lesions. Radical cystoprostatectomy with standard lymphadenectomy, removing all nodal tissue cranially up to the common iliac bifurcation, was performed. Seventeen lymph nodes were excised. The ureters were anastomosed to an ileal conduit (). Final pathologic report revealed a pT2 g3 urothelial carcinoma with no involvement of any lymph nodes, while all surgical margins were clear. After 2.5 years of followup the patient remains free of disease.