Evaluation of Prospective Living Renal Donors for Laparoscopic Nephrectomy with Multisection CT: The Marriage of Minimally Invasive Imaging with Minimally Invasive Surgery1

Department of Radiology, Indiana University Hospital, 550 N University Blvd, Rm 0279, Indianapolis, IN 46202-5253, USA.
Radiographics (Impact Factor: 2.6). 11/2001; 21 Spec No(spec No):S223-36. DOI: 10.1148/radiographics.21.suppl_1.g01oc10s223
Source: PubMed

ABSTRACT Laparoscopic technique for excision of a kidney from a living donor has advantages over conventional open surgery, but operative visibility and surgical exposure are limited. Preoperative multisection computed tomography (CT) can provide necessary anatomic information in a minimally invasive procedure. A three-phase examination is suggested: (a) imaging from the top of the kidneys to the pubic symphysis with a section width of 2.5 mm and no contrast medium, (b) scanning of the kidneys and upper pelvis during the arterial phase of enhancement with a section width of 1.0 mm, and (c) scanning of the kidneys and upper retroperitoneum during the nephrographic phase of enhancement with a section width of 1.0 mm. Emphasis in this article is placed on analysis of the venous anatomy because most radiologists are unfamiliar with the anatomic variations. Conventional radiography of the abdomen and pelvis is performed after CT to evaluate the collecting system and ureters and to provide a lower total radiation dose than if CT were used. Of several postprocessing techniques that may be used, the authors prefer maximum intensity projection for arterial evaluation and multiplanar reformatting for venous evaluation.

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    • "A single topogram is not always sufficient to assess the collecting system, but in most cases it is. In fact, most published authors agree with the use of a delayed topogram with the goal of reducing radiation or even conventional radiography [3, 6–8]. Although it is assumed that taking the patient to the x-ray facility would be more complicated and time consuming, a topogram in the modern CT scanners has a high-quality image. "
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    ABSTRACT: BACKGROUND: Renal vasculature is known for having a broad spectrum of variants, which have been classically reported by anatomists. METHODS: The distribution and morphology of these variations can be explained by considering the embryology of the renal vessels. With the recent outburst of imaging techniques, it has been the radiologist's turn to take the baton, recognising and describing unconventional renal vascular patterns. RESULTS: Knowledge of these patterns has gained significance since the advent of the era of transplantation. For almost 60 years cadaveric donation has been the main source of kidneys suitable for transplantation. Living kidney donation demonstrates many advantages and stands out as the best alternative for organ procurement to meet the increasing demand. Since the dawn of laparoscopic nephrectomy as the technique of choice for organ procurement in living kidney donors, MDCT plays a key role as a noninvasive preoperative planning method for anatomic evaluation. As the field of view at laparoscopic surgery is limited, it is essential to meticulously assess the origin, number, division and course of arteries and veins. CONCLUSION: Awareness of the different anatomical variants allows the radiologist to enlighten the surgeon in order to avoid compromising the safety of the surgical procedure that could lead to significant complications. TEACHING POINTS: • Renal vasculature has many variants, which can be explained by considering the embryology of kidneys. • Living kidney donation demonstrates many advantages over cadaveric donation. • Angio CT evaluation of living kidney donors is a multiple phase study. • A detailed report describing the variants, their distribution and morphology will help surgeons.
    Insights into Imaging 01/2013; 4(2). DOI:10.1007/s13244-012-0217-5
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    • "The prevalence of a supernumerary renal vein has been reported to be in the range from 9-28% (2, 6, 14, 15). Forty-eight kidneys (15.6%) had multiple renal veins in our study, which is concurrent with previous studies. "
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    ABSTRACT: To determine the accuracy of the use of multi-detector row CT (MDCT) to predict vascular anatomy in living kidney donors and to reveal the prevalence of vascular variations in a Korean population. A total of 153 living kidney donors that had undergone preoperative CT and nephrectomy, either with open or laparoscopic surgery, were selected retrospectively. The initial CT results were compared with the surgical findings and repeated review sessions of CT scans were performed to determine the causes of mismatches in discordant cases. The accuracy of CT angiography was 95% to predict the number of renal vessels. Four arteries and two veins were missed during the initial CT interpretation due to perception errors (for two arteries and two veins) and technical limitations (two arteries). The prevalence of multiple renal arteries and veins, early branching of a renal artery and late confluence of a renal vein were 31%, 5%, 12%, 17%, respectively. The circumaortic renal vein and the bilateral inferior vena cava were found in two cases each (1.3%). One case (0.7%) each of a retroaortic renal vein and a supradiaphragmatic originated renal artery were found. MDCT provides a reliable method to evaluate the vascular anatomy and variations of living kidney donors.
    Korean Journal of Radiology 08/2008; 9(4):333-9. DOI:10.3348/kjr.2008.9.4.333 · 1.57 Impact Factor
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    • "Cette dernière étude a également employé un enregistrement numérique vidéo 3-D qui a probablement contribué à ces résultats impressionnants . Tandis que les nouvelles technologies logicielles permettent ce type d'imagerie tridimensionnelle, des études précédentes ont présenté de bons résultats en termes de sécurité obtenus avec l'angiographie tomodensitométrique sans capacité 3-D [51] [52] . Le McGill University Health Center a récemment montré qu'une angiographie tomodensitométrique bidimensionnelle permettait une planification chirurgicale adéquate lorsqu'elle était associée à une dissection laparoscopique et à une coopération complète avec l'équipe de transplantation [53] . "
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    ABSTRACT: Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.
    Annales d Urologie 08/2007; DOI:10.1016/j.anuro.2007.04.006 · 0.36 Impact Factor
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