Design: Video case report and surgical education module.

Setting: Urban academic tertiary care center.

Patients or Participants: A 53 year-old with end-stage renal disease, prior peritoneal dialysis, and a prior failed renal transplant undergoing surgical management of uterine fibroids.

Interventions: Total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, lysis of adhesions, and cystoscopy.

Measurements and Main Results: Intra-operative findings included omental adhesions to the anterior abdominal wall and to the uterine fundus. The transplanted kidney was noted in the preperitoneal space at the right pelvic brim. Cystoscopy revealed bilateral native ureteral orifices and the transplanted ureteral orifice at the right dome of the bladder; no ureteral efflux was noted. Final EBL was 100cc and the patient's postoperative course was uneventful.

Conclusion: Laparoscopic hysterectomy in patients with prior peritoneal dialysis requires careful attention to dissection planes during adhesiolysis. Thorough knowledge of the transplanted renal and ureteral anatomy is required for safe pelvic surgery in patients with a renal transplant.