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 42-year-old male cadaver, with history of prolonged hypertension and death due to cardiac arrest, was dissected routinely. No gross variation was seen in the cadaver. After opening the abdomen a left pelvic kidney was found at the pelvic brim with its medial end in front of sacral promontory close to the bifurcation of the right common iliac artery. First its location, position, and dimensions were analysed and compared to the right kidney. The right kidney appeared normal in position. The dimensions of the left kidney were 13.5 × 6.5 × 2.5 cm, larger than the right kidney whose dimensions were 12 × 5 × 2 cm. The left ectopic kidney was lobulated. Location: the upper pole of left kidney was located at the level of sacral promontory resting over psoas major muscle and inferior pole was present at the S3-S4 intervertebral space. The hilum was anteriorly placed, open with contents exposed to the surface as seen in . The inferior mesenteric artery was arching over the hilum. Three major calyces receiving two minor calyces were visible externally. Superior major calyx was seen reaching the upper pole while middle and inferior major calyces were seen close to the hilum all converging to form pelvis of ureter. Normal hilar relation was disturbed. At the hilum the renal pelvis was present anterior to the inferior left renal vein. The left ureter was tortuous and just 12 cm in length. Both suprarenal glands were present at the level of 12th thoracic vertebra. Blood supply: the left kidney was vascularised by three branches. The first branch arose from the bifurcation of aorta at the level of L4 vertebra; it was 4.5 cm long and descended obliquely to superior pole of kidney. The second branch was 2.5 cm and arose from the right common iliac artery at a slightly lower level (L4-L5) and was seen passing to superior pole. The third branch was 4.3 cm long arising at S5 level from left inferior vesical artery. The ectopic kidney was drained by two renal veins which drained into the right common iliac vein. The superior left renal vein accompanied the second renal artery while the inferior left renal vein emerged through the hilum.\nThe left suprarenal gland was supplied by left inferior phrenic artery and from direct branches from aorta. The left gonadal vein drained directly into the inferior vena cava rather than draining into the left renal vein. Left suprarenal vein drained into IVC.\nThe right kidney was at the normal position. However the hilum was present anteriorly and a bifid renal pelvis could be seen which was also malrotated. Its vascularisation was by a single renal artery originating from aorta. A single renal vein was seen draining into the inferior vena cava. No gross variation was seen in the cadaver.