title: Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria in presence of complex renal vasculature.
abstract: OBJECTIVE
  To evaluate retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) for chyluria in the setting of complex renal vasculature and compare those outcomes with the RRPLD outcomes of patients with normal renal vasculature.
  
  
  METHODS
  From December 2002 to December 2011, RRPLD was performed in 14 patients with complex renal vasculature and 64 patients with normal renal vasculature. Preoperative multislice spiral computed tomography angiography for renal vessels was done on 5 patients with complex vasculature. The demographic and perioperative data were collected to assess critical outcomes.
  
  
  RESULTS
  The abnormal vasculature was identified using preoperative multislice spiral computed tomography angiography in 5 patients and surgical exploration in 9 patients. RRPLD was successfully completed in all patients without conversion to open surgery or vascular injury. The mean operative time was significantly longer in those with complex renal vasculature than those with normal renal vasculature (105.4 ± 18.7 vs 84.5 ± 15.6 minutes; P = .000). The outcomes were similar in the 2 groups in terms of intraoperative blood loss (P = .060), mean hospital stay (P = .478), and intraoperative complications (P = .660). The occurrence of postoperative gross hematuria was significantly greater in those with complex renal vasculature than in those with normal renal vasculature (4 of 14 vs 2 of 64; P = .008). The event was resolved uneventfully.
  
  
  CONCLUSIONS
  Although it is technically challenging, RRPLD is feasible and safe for patients in the presence of complex renal vasculature. Preoperative evaluation of the renal vasculature with multislice spiral computed tomography angiography is beneficial for managing abnormal renal vessels.
authors.affiliation: Department of Urology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors.forename: Cheng-Jing
authors.initials: CJ
authors.lastname: Zhang
authors.forename: Ren-Fu
authors.initials: RF
authors.lastname: Chen
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Zhu
authors.forename: Ru-Min
authors.initials: RM
authors.lastname: Wen
authors.forename: Jia-Cun
authors.initials: JC
authors.lastname: Chen
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Sun
mesh_terms: D000328:Adult; D002913:Chyle; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging; D010535:Laparoscopy; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012077:Renal Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012082:Renal Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012187:Retroperitoneal Space; D014463:Ultrasonography; D014556:Urine; D013520:Urologic Surgical Procedures / Q000379:methods*