827 EXPERIMENTAL MODEL OF LOWER POLE NEPHRECTOMY USING HUMAN TRIDIMENSIONAL ENDOCASTS: ANALYSIS OF VASCULAR INJURIES

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013827 EXPERIMENTAL MODEL OF LOWER POLE NEPHRECTOMY USING HUMAN TRIDIMENSIONAL ENDOCASTS: ANALYSIS OF VASCULAR INJURIES luciano favorito and francisco jose b. sampaio luciano favoritoluciano favorito rio de janeiro, Brazil More articles by this author and francisco jose b. sampaiofrancisco jose b. sampaio rio de janeiro, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.394AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A good understanding of intrarenal anatomy, especially in relation to lower pole vessels, is of utmost importance for laparoscopy and robotic surgery in nephron-sparing surgery. The aim of the present study is to establish an experimental model for lower pole nephrectomy using tridimensional endocasts of human kidneys. METHODS We studied 38 kidneys from adults. The ureters, veins and arteries (ART) were dissected and injected with yellow, blue and red polyester resin, respectively. While this resin was still in gel state, we performed upper pole guillotine sections at various distances from the hilar zone, thereby dividing our sample in four groups: (a) hilar zone (11 kidneys); (b) 0.5cm from the hilar zone (12 kidneys); (c) 1.0cmfrom the hilar zone (8 kidneys); and (d) 1.5cm from the hilar zone (7 kidneys). After polymerization of the resin, kidney samples were placed in HCl for corrosion of organic matter, which yielded tridimensional endocasts of the arterial, venous and collecting systems. We then examined the casts for damaged structures. To perform the contingence analysis of the populations studied we used Fisher's exact test (p<0.05). RESULTS Retropelvic artery was not damaged in the 38 cases. Hilar zone: A) ART: In 4 cases (36.36%), lower segmental artery (LSA) was injured. All cases in this group presented injury of infundibular art. B) VEINS: In five cases (45.45%) occurred damage of the lower venous trunk (LVT). All cases in this group presented damage of interlobular, arcuate and stellate veins. 0.5 from the hilar zone: A) ART: LSA was injured in 1 case (8.3%). In all cases infundibular art were damaged. B) VEINS: In four cases (33.3%) occurred damage of the LVT. All cases in this group presented damage of interlobular, arcuate and stellate veins. 1.0 from the hilar zone: A) ART: LSA was not damaged in this group. In all cases infundibular art were damaged. B) VEINS: LVT was not damaged in this group. Interlobular veins were damaged in 3 out of 11 cases (27.27%). All cases in this group presented damage of arcuate and stellate veins. 1.5 from the hilar zone: A) ART: LSA was not damaged in this group. In all cases we observed damage of the infundibular art. B) VEINS: There was no damage to LVT and interlobar veins. Arcuate veins were damaged in 4 of 7 cases (57.14%). All cases of this group presented damage to stellate veins. CONCLUSIONS Lower pole nephrectomies performed at less than 1.0cm from the hilar zone presented a significant high incidence of injuries in larger arteries and veins. Nephrectomies at this level should therefore be avoided or performed with maximum care. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e339 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information luciano favorito rio de janeiro, Brazil More articles by this author francisco jose b. sampaio rio de janeiro, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...