title: Prospective comparison of 3-dimensional volume rendered computerized tomography and conventional renal arteriography for surgical planning in patients undergoing laparoscopic donor nephrectomy.
abstract: OBJECTIVE
  We prospectively assessed the accuracy of 3-dimensional (3-D) volume rendered computerized tomography (CT) and conventional renal arteriography to visualize renovascular anatomy in patients undergoing laparoscopic donor nephrectomy.
  
  
  METHODS
  A total of 60 consecutive patients undergoing laparoscopic donor nephrectomy (left side in 46 and right side in 14) prospectively underwent 3-D CT and renal angiography. A short videotape of 3-D CT was prepared using volume rendering software that demonstrated the anatomical location, number, anomalies and spatial interrelationships of the renal arteries and veins. These 3-D videotapes and arteriogram findings were directly correlated with intraoperative surgical findings at laparoscopy and during ex vivo bench preparation of the harvested kidney. The perceived intraoperative value of 3D-CT to delineate renovascular anatomical detail was scored subjectively by the laparoscopic surgeon for each case on a 10-point scale of 0--completely inaccurate to 10--completely accurate.
  
  
  RESULTS
  There were no complications related to the 3-D CT protocol and volume rendering was successful in all patients. Three-D CT accurately identified the number of renal arteries in 59 patients (98%). In 1 patient with 3 renal arteries 3-D CT and arteriogram each identified only 2. In the 46 patients undergoing left donor nephrectomy 3-D CT accurately identified the number of veins and venous anomalies in 45 (98%), including 2 with a circumaortic left renal vein. Another case of circumaortic vein was misdiagnosed as 2 renal veins. On the right side in 14 patients 3-D CT accurately identified the renal veins in 13 (94%) and missed 1 vein in a patient with 2 renal veins. Angiography correctly identified the number of renal veins in only 52 cases (87%). Furthermore, it misdiagnosed all 3 cases of circumaortic left renal vein. The laparoscopic surgeon believed that 3-D CT accurately identified the location and anatomical interrelationship of the renal vessels with precision. Mean subjective score +/- SEM was 8.5 +/- 1 for the arterial system, 8.6 +/- 1.1 for the venous system and 9.2 +/- 0.5 for any vascular anomalies.
  
  
  CONCLUSIONS
  Three-D CT accurately identifies renal vascular anatomy in a manner that may facilitate renal hilar dissection during laparoscopic donor nephrectomy, especially during the initial surgeon experience. This imaging modality integrates essential information from angiography, venography and excretory urography into a single study, and it can obviate the need for more invasive vascular imaging in most cases.
authors.affiliation: Section of Laparascopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA.
authors.forename: Hazem Abou
authors.initials: HA
authors.lastname: El Fettouh
authors.forename: Brian R
authors.initials: BR
authors.lastname: Herts
authors.forename: Toni
authors.initials: T
authors.lastname: Nimeh
authors.forename: Susan L
authors.initials: SL
authors.lastname: Wirth
authors.forename: Audrey
authors.initials: A
authors.lastname: Caplin
authors.forename: Mark
authors.initials: M
authors.lastname: Sands
authors.forename: Anup P
authors.initials: AP
authors.lastname: Ramani
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: David A
authors.initials: DA
authors.lastname: Goldfarb
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000792:Angiography; D003287:Contrast Media; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007472:Iohexol / Q000031:analogs & derivatives*; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging*; D009392:Nephrectomy; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide