Experimental Model of Upper-Pole Nephrectomy Using Human Tridimensional Endocasts: Analysis of Vascular Injuries

Abstract

The aim of the study is to establish an experimental model for upper-pole nephrectomy using tridimensional endocasts of human kidneys. We studied 104 kidneys from 52 adults. The ureters, veins, and arteries were dissected and injected with yellow, blue, and red polyester resin, respectively. While this resin was still in the 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: 22 kidneys (10 with vein and ureter injection); B. 0.5 cm from the hilar zone, 32 kidneys (9 with vein and ureter); C. 1.0 cm from the hilar zone, 24 kidneys (11 with vein and ureter); and D. 1.5 cm from the hilar zone, 26 kidneys (6 with vein and ureter). We also determined the mean distance from the retropelvic artery to the section plane. Sections performed at the hilar region and at 0.5 cm from hilar region had an alarming rate of injuries to the retropelvic artery and vein, upper segmental artery, and upper venous trunk. In both groups, the distance between the section plane and retropelvic artery was a mean less than 1.0 cm. Sections performed at 1.0 cm and at 1.5 cm from the hilar region had a significantly lower injury rate, with mean distance between section plane and retropelvic artery more than 1.0 cm. Upper-pole nephrectomies performed at less than 1.0 cm from the hilar zone had a significantly high incidence of injuries in larger arteries. Nephrectomies at this level should therefore be avoided or performed with maximum care.