Routine undergraduate dissection for medical students in our department revealed a unilateral non-rotated kidney on the left side in a 97-year-old male cadaver. The body was donated to our department for teaching and research purposes. The cause of death was cardiopulmonary arrest.\nThe right kidney was found to be normal in its location, shape, size, and ureter formation. Varied vasculature was observed in the form of branches of the renal artery and formation of the renal vein. The left kidney was found to be at a lower position than usual, at the level of the second, third, and fourth lumbar vertebrae. The inferior pole was at the level of the L4-L5 intervertebral disc. The kidney was broader near its middle third and inferior pole. The cratered hilum of the left kidney, instead of being at its medial border, occupied a large part of the anterior surface and was situated nearer to the lateral than the medial border. The renal vein and ureter were the two structures traversing through the hilum, but the renal artery was entering the renal parenchyma through the medial border.\nThe structures emerging from the hilum of the kidney mainly comprised the renal vein and the tubular ureter. The renal vein had two major tributaries, superior and inferior. The inferior tributary was formed by joining two tributaries emerging from the inferior region of the renal parenchyma and proceeded obliquely upward and medially to join with the superior renal vein. The left gonadal vein drained into this inferior tributary. The main trunk of the renal vein traversed its usual course between the abdominal aorta and superior mesenteric artery to drain into the inferior vena cava. There was no well-defined renal pelvis; instead the tubular ureter had four divisions entering into the renal parenchyma at the hilum of the kidney (labeled a, b, c, and d in ). The course of the ureter was then downward and medial to the urinary bladder.\nThe abdominal aorta was tortuous all along its course in the abdomen. The Main Renal Artery (MRA) is described as a single vessel, at a more or less constant position opposite the renal hilus, from the abdominal aorta, and which continues undivided (except for several small branches- the inferior suprarenal, the perirenal and the ureteral arteries) in its straight course to the renal hilus. The MRA was thin and originated from the abdominal aorta at a level just inferior to the origin of the superior mesenteric artery, entering the kidney through its medial border after giving off 3 branches (represented by red asterisks in and ) to the left suprarenal gland. The accessory renal artery (AcRA) arose from the aorta just lateral and inferior to the origin of the inferior mesenteric artery, entering the renal parenchyma through the medial border of the kidney. The AcRA divided into two segmental arteries before piercing the lower part of the medial border of the kidney ().\nThe case was observed in a body donated to our department for educational and research purposes. Body is accepted only after taking consent of the deceased/next of kin which is in accordance to Anatomy act of India.
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.