title: A radiological investigation of the hepatorenal space: the importance of the ventral decubitus for safer percutaneous right renal access.
abstract: We investigated anatomical and radiological morphometric parameters, aiming to minimize the risk of hepatic and colonic injuries during right percutaneous kidney access under either ventral or dorsal decubitus of patients. Prone and supine abdominal computerized tomographic examinations from 31 normal adult volunteers (men = 12; women = 19; without history of abdominal pathology) were analyzed morphometrically in order to study the dynamic anatomical relations between the liver and the right kidney. The age of the volunteers ranged from 22 to 64 years old (mean +/- SD = 42.77 +/- 2.10). We observed a significantly greater distance between the liver and the right kidney (hepatorenal space) when the examinee is positioned in ventral decubitus (3.93 +/- 0.37 cm) in comparison with dorsal decubitus (1.98 +/- 0.20 cm). Accordingly, we conclude that right percutaneous access to the inferior right renal pole implies a significantly lower risk (P < 0.01) of both hepatic and biliary injuries when performed in ventral decubitus, comparatively to dorsal decubitus.
authors.affiliation: Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), CCS, Bloco F, Cidade Universitária, Rio de Janeiro, RJ, 21941-590, Brazil.
authors.forename: Manoel Antonio Gonçalves
authors.initials: MA
authors.lastname: Pombo
authors.forename: Luciana da Silva
authors.initials: Lda S
authors.lastname: Pombo
authors.forename: Bernardo
authors.initials: B
authors.lastname: De-Ary-Pires
authors.forename: Mário Ary
authors.initials: MA
authors.lastname: Pires-Neto
authors.forename: Ricardo
authors.initials: R
authors.lastname: de Ary-Pires
mesh_terms: D000328:Adult; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007668:Kidney / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D008099:Liver / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D056888:Patient Positioning / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016684:Prone Position / Q000502:physiology*; D011859:Radiography; D012727:Sex Characteristics; D016683:Supine Position / Q000502:physiology*; D055815:Young Adult