Objective: To describe the feasibility of retroperitoneal laparoscopic reimplantation of the left renal vein (LRV) for nutcracker syndrome (NCS). Patients and Methods: Two patients with NCS underwent the surgery. Both patients complained of gross hematuria and flank discomfort that could not be relieved by resting. They were placed in a supine position and 5 ports were placed in the right abdominal wall. The procedures were performed with a retroperitoneal approach. The LRV was transected and then reimplanted into the distal inferior vena cava. Results: The procedures were performed successfully without any major complications. The total operation time was 105 and 120 min, respectively. Hematuria and flank discomfort were resolved after the surgery. Ultrasonography revealed a patent lumen without compression. Conclusions: Retroperitoneal laparoscopic reimplantation of the LRV appears to be a feasible procedure with satisfactory short-term outcomes.

1.
Reed NR, Kalra M, Bower TC, Vrtiska TJ, Ricotta JJ 2nd, Gloviczki P: Left renal vein transposition for nutcracker syndrome. J Vasc Surg 2009;49:386-393.
2.
Chen S, Zhang H, Shi H, Tian L, Jin W, Li M: Endovascular stenting for treatment of nutcracker syndrome: report of 61 cases with long-term follow-up. J Urol 2011;186:570-575.
3.
Barnes RW, Fleisher HL III, Redman JF, Smith JW, Harshfield DL, Ferris EJ: Mesoaortic compression of the left renal vein (the so-called nutcracker syndrome): repair by a new stenting procedure. J Vasc Surg 1988;8:415-421.
4.
Chung BI, Gill IS: Laparoscopic splenorenal venous bypass for nutcracker syndrome. J Vasc Surg 2009;49:1319-1323.
5.
Xu D, Gao Y, Chen J, Wang J, Ye J, Liu Y: Laparoscopic inferior mesenteric-gonadal vein bypass for the treatment of nutcracker syndrome. J Vasc Surg 2013;57:1429-1431.
6.
Thompson PN, Darling RC III, Chang BB, Shah DM, Leather RP: A case of nutcracker syndrome: treatment by mesoaortic transposition. J Vasc Surg 1992;16:663-665.
7.
Hohenfellner M, D'Elia G, Hampel C, Dahms S, Thuroff JW: Transposition of the left renal vein for treatment of the nutcracker phenomenon: long-term follow-up. Urology 2002;59:354-357.
8.
Hartung O, Azghari A, Barthelemy P, Boufi M, Alimi YS: Laparoscopic transposition of the left renal vein into the inferior vena cava for nutcracker syndrome. J Vasc Surg 2010;52:738-741.
9.
Qin C, Shao P, Meng X, Li P, Cao Q, Lv Q, et al: Extraperitoneal laparoscopic retroperitoneal lymph node dissection for early-stage testicular nonseminomatous germ cell tumors: initial experience. J Endourol 2012;26:1203-1209.
10.
Rassweiler JJ, Frede T, Lenz E, Seemann O, Alken P: Long-term experience with laparoscopic retroperitoneal lymph node dissection in the management of low-stage testis cancer. Eur Urol 2000;37:251-260.
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