Laparoscopic Colectomy for a Patient with Congenital Renal Agenesis
A 57-year-old man presented to our institute for further evaluation following a positive result in an fecal occult blood test. Approximately 20 years earlier, he was diagnosed with congenital agenesis of the right kidney. He was otherwise entirely healthy without any other significant past or current medical problems. A physical examination showed no abnormalities of the genitourinary system. A contrast-enhanced computed tomography of the abdomen indicated the absence of the right kidney and a hypertrophic left kidney [], and indicated the presence of the right testicular vessels located behind the renal fascia [], but no other anomalies were observed. Total colonoscopy revealed the presence of a tumor, measuring 1.5 cm × 1.0 cm in the ascending colon; the tumor could not be elevated by injection of saline into the submucosal layer. Because endoscopic treatment was impossible, we performed laparoscopic colectomy and lymph node dissection.\nThe operative procedures and findings are as follows. The subumbilical trocar was initially placed using the open laparoscopic technique. After CO2 pneumoperitoneum was established, three other ports were placed. No particular findings such as ascites, adhesion, peritoneal seeding, or anatomical anomalies were noted in the abdominal cavity. The right colon was mobilized to the root of mesocolon by lateral-to-medial extension of retroperitoneal dissection between the fusion fascia and the anterior renal fascia. This procedure was performed in the usual manner. The right testicular vessels were observed behind the anterior renal fascia; however, the right ureter could not be detected []. Furthermore, we could not detect the right renal and adrenal vessels within the operative field. The ileocolic and right colic vessels were ligated near these origins using endoscopic clips, and were mobilized divided. After the segment of the colon was completely mobilized, the ileum and colon were extracted from the abdominal cavity via a right pararectal incision and were then divided. After Gambee's hand-sewn end-to-end anastomosis was performed, the intestine was placed back into the abdominal cavity. During laparoscopy, the abdominal cavity was irrigated, a drain tube was placed at the paracolic gutter, and all other ports were removed. The incisions were closed using absorbable sutures and staples. Histological examination showed a well-differentiated adenocarcinoma that invaded to the submucosal layer without infiltration to the vessels or lymph ducts. No lymph node metastases were detected. The postoperative course was uneventful except for ileus, which was treated conservatively. The patient is currently healthy; he is receiving regular follow-up examination, and has no signs of recurrence and other malignancies.