Single-Position Intraperitoneal Laparoscopic Nephroureterectomy and Retroperitoneal Lymph Node Dissection in Modified Supine Position: Technical Adaptation for Double Inferior Vena Cava

Abstract

Clinical History: A 51-year-old male presented with a 2-month history of asymptomatic gross hematuria.

Physical Exam:

Physical examination revealed left renal angle tenderness upon percussion.

Diagnosis:

Contrast-enhanced CT imaging identified a solid mass within the left renal pelvis, accompanied by severe hydronephrosis. The scan also delineated a double inferior vena cava (d-IVC), with the left IVC draining into the left renal vein. The clinical stage was cT2N0M0.

Intervention:

The patient underwent a laparoscopic radical nephroureterectomy (LRNU) performed using a novel single-position intraperitoneal laparoscopic surgery (SP-ILS) technique. Key technical modifications included: (1) an orientation strategy to facilitate comprehensive retroperitoneal lymph node dissection without intraoperative repositioning and (2) a cava sling technique to optimize surgical exposure given the d-IVC anatomy.

Follow-up/Outcomes:

The total operative time was 135 minutes, with an estimated blood loss of 30 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 3. Final pathology confirmed high-grade invasive urothelial carcinoma with renal parenchymal invasion (pT2N0M0), with no lymph node metastasis.

All authors report no conflicts of interest or financial ties to disclose.

Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

The study was supported by the Natural Science Foundation of Guangdong Province (NO.2023A1515011664).

Runtime of video: 4 mins 56 secs.