Preoperative evaluation of renal artery anatomy using computed tomography angiography to guide the superselective clamping of renal arterial branches during a laparoscopic partial nephrectomy.

ABSTRACT

The aim of the present study was to evaluate the clinical value of preoperative computed tomography angiography (CTA) imaging for guiding the superselective clamping of renal arterial branches during a laparoscopic partial nephrectomy (LPN). A total of 42 patients with renal masses of <4 cm, who had undergone a LNP, were retrospectively enrolled in the study between May 2008 and December 2013. CTA was performed preoperatively and the renal arterial anatomy was evaluated independently by two radiologists. Surgical observations, including the number, location and branching patterns of the renal arteries, were documented by the surgeon. Subsequently, the description of the renal arterial anatomy obtained using CTA was compared with the actual renal vascular structure observed during surgery. In total, 42 patients successfully underwent an LNP with superselective clamping of the renal arterial branches. The accuracy of CTA for the detection of the renal artery and renal tumor-feeding branches was 97.6 and 85.7%, respectively. The CTA images facilitated the correct identification of 36/36 single renal arteries (100%), while 5/6 renal accessory arteries were preoperatively detected using the CTA images. Statistical analyses indicated no statistically significant differences between the preoperative CTA and surgical LPN results for the number of clamped segmental arteries. Therefore, CTA was demonstrated to accurately visualize renal vascular anatomy and provide an advantage by enhancing the detection of tumor-feeding arteries. Thus, the use of CTA may facilitate improved segmental renal artery clamping during LPN.