Application of combined computed tomography arteriography, venography, and urography in laparoscopic partial nephrectomy with segmental artery clamping.

Abstract

To evaluate the role of combined computed tomography (CT) arteriography (CTA), venography, and urography in laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping. Seventy-five patients underwent laparoscopic partial nephrectomy with segmental renal artery clamping. Three-dimensional (3D) CTA, CT venography, and CT urography models were reconstructed and combined before surgery. Surgeries were performed using these 3D models for surgical orientation. All procedures were performed successfully without conversion to main renal artery clamping. The mean operative time was 82.6 minutes, and the mean clamping time of target arteries was 20.3 minutes. Grade-I and grade-II complication rates were 5.3% and 5.3%, respectively. Compared to orientation with CTA alone, the use of the combined 3D model resulted in a modification of the planned hilar approach for target dissection in 18 cases (24%). Tumor location correlated with modification of the planned hilar approach. Lower pole tumors were treated with a modification of the hilar approach 58.3% of the time, and 37.5% of striding tumors were treated with a modified approach (P = .001). Only 11.1% of anterior tumors and no posterior or upper pole tumors underwent modification of the hilar approach after evaluation with the combined 3D model. Tumor size and tumor growth pattern did not affect the distribution of approach modifications (P = .89 and P = .52). The combined 3D model seems to facilitate target artery orientation and surgical dissection. The combined model may alter the surgical approach used for some lower pole or striding renal tumors compared to the approach suggested by conventional CTA.