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Helical CT 3D reconstruction of renal vessels. Is it accurate? Does it aid hilar dissection in transperitoneal (non‐hand assisted) laparoscopic nephrectomy and nephro‐ureterectomy
Author(s) -
TAN A.F.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06085_49.x
Subject(s) - nephrectomy , medicine , dissection (medical) , urology , radiology , kidney
Laparoscopic Nephrectomy is increasingly accepted as the choice of treatment in patients who are undergoing nephrectomies. Current indications include renal cell carcinoma (T1 and T2), TCC of upper tract and non‐functioning kidneys. It remains a technically challenging procedure. The dissection of the hilum can be quite demanding, time consuming and stressful to the urologist. We explore the possible advantage of preoperative 3D‐CT reconstruction images of the renal vessels. Method: The prospective study involved 46 consecutive patients who were undertaking laparoscopic nephrectomies. All the patients had preoperative 3D‐CT and data were collected regarding location, number, anomalies and spatial inter‐relationship of the renal artery and vein. These were then correlated with intra operative data. Other information included peri operative blood loss, transfusion, conversion, hilar dissection time and operative time. These were compared with 26 patients who had previously undergone nephrectomies without the 3D‐CT. Results: The 3D‐CT was accurate in predicting the location and the anatomical relationship of the vessels in all the cases. However, it predicted the accurate number of arteries and veins in 90% and 80% respectively. With the imaging we were able to reduce the hilar dissection time (20 min), overall operative time (75 min) and blood loss. There was no conversion in the 46 patients. Conclusion: 3D‐CT is an invaluable tool preoperative for patient considered for laparoscopic nephrectomies. It aids hilar dissection by predicting the inter‐relationship of the vessels. However, the surgeon must remain vigilant, as there may be more unsuspected vessel around the corner.