Article

Evaluation of prospective living renal donors for laparoscopic nephrectomy with multisection CT: The marriage of minimally invasive imaging with minimally invasive surgery

Department of Radiology, Indiana University Hospital, 550 N University Blvd, Rm 0279, Indianapolis, IN 46202-5253, USA.
Radiographics (Impact Factor: 2.73). 11/2001; 21 Spec No(spec No):S223-36.
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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    • "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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    • "1–3). Computed tomography angiography (CTA) is well established as a non-invasive technique for imaging of the renal arteries and other visceral abdominal arteries [8] [9] [10] [11] [12] [13] [14] [15]. However, whereas the main renal arteries can be reliably displayed, imaging of the aberrant arteries and branching of the main arteries is not so frequently used as that of the stem arteries [16]. "
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    ABSTRACT: Objective: To show that it is possible to reduce the radiation dose in the examination of potential kidney donors by splitting the contrast injection followed by a single scanning, enabling evaluation of vascular structures, renal parenchyma and collecting system/ ureters, using computed tomography protocols with reduced mAs. Methods : Twenty-six potential donors were evaluated based on the following criteria: image quality, radiation dose reduction, and complications associated with the exam. The criteria were scored by two examiners, and the differences were resolved by consensus. results : For each item assessed, 85 to 90% of studies were scored as very good or excellent with regards to image quality. There was excellent interobserver agreement, and there were no significant differences between the exams with low radiation dose compared to those with the conventional dose. No exam-related complications were observed. conclusions : The CT scan study with triple-split bolus technique and low dose is effective for reducing the dose of radiation to potential kidney donors.
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