case_images: PMC11670782_01
case_images: The yellow arrow in the retrograde pyelography shows a ureteral tumor in the upper ureter (a). There were no findings suggestive of metastases, and the clinical diagnosis was right ureteral carcinoma T2N0M0. An axial (b) and coronal (c) computed tomography view show the right kidney in the thorax with protrusion of the diaphragm, suggesting a thoracic kidney.
case_images: rjae815f1.jpg
case_images: PMC11670782_01_rjae815f1.jpg
case_images: f1
case_images: Ureteral carcinoma was diagnosed as cT2N0M0 (Fig. 1a). The origin of the right renal artery and the entry of the renal vein were at the same level as those of the contralateral kidney (Fig. 1b).
case_images: Port position at the beginning of retroperitoneal laparoscopic surgery (a).  indicates the port for the camera,   refers to the 12 mm left and right ports for manipulation, and   is the 5 mm port site for the assistant. (b, c) Manipulation of renal vessels was complex because the forceps could not reach the suprahilar area through the lateral ports ( ). Dotted lines indicate the ribs. RA: renal artery.
case_images: rjae815f2.jpg
case_images: PMC11670782_01_rjae815f2.jpg
case_images: f2
case_images: The ports were placed as shown in Fig. 2a. Forceps could not reach the suprahilar area via the lateral port because the iliac crest interfered with forceps movement (Fig. 2b).
case_images: (a) A 5 mm port added at the intercostal site (arrow). Dotted lines indicate the ribs. (b) The additional intercostal port secured access to the supra hilar area (arrow), allowing for safe renal vascular control and manipulation of the superior aspect of the kidney. RV: renal vein.
case_images: rjae815f3.jpg
case_images: PMC11670782_01_rjae815f3.jpg
case_images: f3
case_images: Therefore, according to the preoperative plan, a 5 mm port was added at the intercostal site, as indicated in Fig. 3a. The port also secured the handling of the superior aspect of the kidney and the successful completion of laparoscopic surgery (Fig. 3b).