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+A 56-year-old woman was initially evaluated for intestinal disorders. Initial physical examination and routine laboratory workup were normal. An abdominal ultrasound revealed a 12 cm solid mass behind the left kidney with abnormal vascularity. Computed tomography showed a well-circumscribed mass behind the left kidney that enhanced after intravenous contrast administration and had a clear fatty plane between the left kidney and the mass. A fine needle puncture was performed to obtain histology. The pathology report was of a benign or low malignant potential mesenchymal tumour. Laparoscopic exploration was decided.
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+Surgical technique: Under general anaesthesia the patient was positioned in right lateral decubitus after placement of an orogastric and bladder catheter. A single dose of cephalothin 2gr was administered intravenously. Pneumoperitoneum was performed with a Veress needle at 12 mmHg. Two trocars of 1 2 mm and 5 mm respectively were placed forming a rhombus as shown in Figure 3. The colon and spleen were widely mobilised towards the midline. After opening Gerota's fascia the mass was clearly visualised over the outer edge of the kidney. Preserving the tumour borders, the mass was released from its contact with the renal capsule. An area of 2cm was observed firmly adhered to the renal capsule requiring resection and subsequent argon laser fulguration of the cruciate bed. The surgical specimen was removed in a plastic bag by oblique extension of the left flank trocar incision. A Blake drain was left through the 5 mm trocar opening. The operative time was 135 minutes with an estimated bleeding of 200 ml. The patient progressed favourably and was discharged on the third postoperative day. The final pathological analysis revealed a very low grade leiomyosarcoma. After a follow-up of 6 months the patient has recovered completely with no evidence of her underlying disease.
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