Laparoscopic radical nephrectomy in ACDK-associated renal cell carcinoma accompanied by duplicated IVC: a case report

Abstract

A 59-year-old male patent who had undergone chronic dialysis for 13 years presented with gross hematuria. Radiological examinations showed a cystic renal tumor in the left kidney, multiple renal cysts due to acquired cystic disease of the kidney (ACDK), and a duplicated inferior vena cava (IVC). Although we suspected that the branches of the left IVC might be anormalous with regard to number and location, we could not obtain information about the left renal vein by 3-dimensional computed tomography because of the decreased blood flow in the end-stage kidney. Laparoscopic radical nephrectomy was performed using a transperitoneal approach. We first identified the left IVC and then exposed its surface widely so that we could identify the veins draining into it. We identified and divided two renal veins and also identified an adrenal vein and a gonadal vein draining directly into the left IVC. The enlarged kidney with multiple renal cysts was removed in a purely laparoscopic procedure.

症例は13年間透析を行っている59歳, 男性。血尿を主訴に受診し, 画像診断で左腎上極の嚢胞性腫瘤, ACDKによる多発性の腎嚢胞, そして重複下大静脈を認めた。腎静脈を含む左下大静脈からの分枝の数や位置に関して先天的な異常の可能性があると考えられたが, 3次元 CTによる検討では終末腎のため腎血流が減少し, 左腎静脈の情報は得られなかった。経腹膜的に腹腔鏡下根治的腎摘除術を施行した。左下大静脈を最初に同定しその表面に沿って広い範囲で剥離することにより, 左下大静脈に流入する静脈を同定することができた。2本の腎静脈とさらに左下大静脈に直接流入する副腎静脈と性腺静脈を確認できた。腎嚢胞が多発し腫大した腎臓であったが, pure laparoscopicな手技で切除することができた。