A Case of Lymphocele After Kidney Transplantation in a Severely Obese Patient Successfully and Safely Treated by Laparoscopic Fenestrated Resection With a Fluorescent Ureteral Stent.

Lymphocele is a frequent complication of renal transplantation and can be difficult to manage. Surgical intervention requires precise identification of the ureter owing to anatomical variability in the urinary tract after transplantation. We herein report a 61-year-old obese man (body mass index 33.4 kg/m2) who developed pelvic lymphocele after living donor renal transplantation. Initial conservative observation was followed by percutaneous drainage due to progressive leg edema, hydronephrosis, and elevated serum creatinine levels (3.3 mg/dL). Although drainage improved renal function and reduced edema, persistent high-output drainage of 500 mL/day necessitated laparoscopic fenestration. Given the anticipated difficulty in identifying the ureter due to obesity, a near-infrared fluorescent ureteral catheter was inserted preoperatively. Intraoperative near-infrared imaging enables visualization of the ureter, facilitating fenestration at a safe distance. Furthermore, observing fluorescence within the lymphocele allowed for clearer identification of the ureteral location.