Multidetector CT imaging of complications after laparoscopic nephron-sparing surgery.

Massimo Tonolini,Anna Maria Ierardi,Virginia Varca,Giacomo Piero Incarbone,Roberto Bianco,Marina Petullà

doi:10.1007/s13244-015-0413-1

Massimo Tonolini, Anna Maria Ierardi + Show 4 more

Open Access

https://doi.org/10.1007/s13244-015-0413-1

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Abstract

PurposeLaparoscopic nephron-sparing surgery (L-NSS) is increasingly performed to treat localised renal lesions. However, the associated morbidity is non-negligible, with a rate of major complications approaching 10 %.Methods and ResultsThis paper provides an overview of indications, surgical techniques and results of L-NSS; explains the incidence, risk factors and manifestations of postoperative complications; discusses the preferred multidetector computed tomography (CT) acquisition techniques; illustrates the appearance of normal postoperative images following L-NSS; and reviews, with example images, the most common and unusual iatrogenic complications. These include haematuria, haemorrhage, vascular injuries, infections and urinary leaks. Most emphasis is placed on CT, which provides rapid, reliable triage and follow-up of iatrogenic complications after L-NSS, identifying occurrences that require transarterial embolisation or repeated surgery.ConclusionsMultidetector CT allows precise assessment of the surgical resection site; detection of pneumoperitoneum and subcutaneous emphysema; quantification of retroperitoneal blood; and identification of active bleeding, pseudoaneurysms, arterio-venous fistulas, abscess collections and extravasated urine.Teaching Points• Laparoscopic nephron-sparing surgery (NSS) is increasingly performed to treat renal lesions.• Radiologists are increasingly requested to investigate suspected post-surgical NSS complications.• Post-NSS complications include haemorrhage, haematuria, vascular injuries, infections and urinary leaks.• Multidetector CT allows choice between conservative treatment, transarterial embolisation or surgery.

Highlights

BackgroundAs a result of improved surgical techniques and greater focus on minimising functional impairment over the last decade, the therapeutic approach to localised renal cell carcinoma (RCC) has evolved from the classical radical nephrectomy (RN) towards nephron-sparing surgery (NSS), which was initially performed using an open surgical approach
The widespread use of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) has led to a steady increase in the detection of benign, malignant or indeterminate renal lesions requiring surgery, so that currently almost 50 % of RCCs are diagnosed incidentally, often during imaging studies requested for unrelated reasons
According to the most recent guidelines from the European Association of Urology (EAU) [1, 2], NSS represents the treatment of choice for localised RCC

Summary

Conclusions

In most patients with suspected postoperative complications after L-NSS, urgent multidetector CT imaging allows detection of intraluminal and peri-renal haemorrhage, active bleeding, vascular injuries, extravasated urine and infections.

Background

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