Application of CT angiography in laparoscopic nephron-sparing surgery for renal tumors

Abstract

Objective To discuss the application value of CT angiography (CTA) in evaluating renal artery anatomy of laparoscopic nephron-sparing surgery (LNSS) before operation. Methods Retroperitoneal LNSS was performed in 87 patients with renal tumors. Forty cases underwent CTA before LNSS, volume rendering and maximum intensity projection of renal artery were used as three-dimensional reconstruction. The other 47 without CTA were compared as control. Treatment out-comes of the 2 groups were compared, including operation time, warm ischemia time, blood loss, con-version to open surgery, hospitalization stay after operation, and complications after operation. Re-sults All the procedures were completed laparoscopically with no conversion to open surgery in CTA group. One patient underwent conversion to open surgery in the control group. In CTA and control group, the operation time was 94 min(range, 76-118)and 115 min(90-190, P<0.05). The warm ischemia time was 23 min(12-39)and 29 min(18-40, P<0.05). Blood loss was 90 ml(9.0-160) and 130 m1(90-600, P<0.01). Hospitalization stay after operation was 4.1 d(3-5) and 5.5 d(3-9), respectively(P<0.05). The pathologic examination showed negative surgical margin in all cases of renal cell carcinoma. The patients were followed up for 4 months to 32 months. Neither distant nor local recurrences were observed, and the renal function was normal in all cases. Urinary leakage oc-curred in 1 patient of each group. Conclusions CTA could be an effective method in evaluating the supply blood vessels of kidney before LNSS. And it can shorten the operation time and warm ischemia time, reduce the blood loss, as the result of helping the operaters deal with renal artery more quickly and accurately. Key words: Kidney neoplasms; Laparoscopes; Nephron-sparing surgery; Tomography, X-ray computed; Reconstruction