title: Application of combined computed tomography arteriography, venography, and urography in laparoscopic partial nephrectomy with segmental artery clamping.
abstract: OBJECTIVE
  To evaluate the role of combined computed tomography (CT) arteriography (CTA), venography, and urography in laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping.
  
  
  METHODS
  Seventy-five patients underwent laparoscopic partial nephrectomy with segmental renal artery clamping. Three-dimensional (3D) CTA, CT venography, and CT urography models were reconstructed and combined before surgery. Surgeries were performed using these 3D models for surgical orientation.
  
  
  RESULTS
  All procedures were performed successfully without conversion to main renal artery clamping. The mean operative time was 82.6 minutes, and the mean clamping time of target arteries was 20.3 minutes. Grade-I and grade-II complication rates were 5.3% and 5.3%, respectively. Compared to orientation with CTA alone, the use of the combined 3D model resulted in a modification of the planned hilar approach for target dissection in 18 cases (24%). Tumor location correlated with modification of the planned hilar approach. Lower pole tumors were treated with a modification of the hilar approach 58.3% of the time, and 37.5% of striding tumors were treated with a modified approach (P = .001). Only 11.1% of anterior tumors and no posterior or upper pole tumors underwent modification of the hilar approach after evaluation with the combined 3D model. Tumor size and tumor growth pattern did not affect the distribution of approach modifications (P = .89 and P = .52).
  
  
  CONCLUSIONS
  The combined 3D model seems to facilitate target artery orientation and surgical dissection. The combined model may alter the surgical approach used for some lower pole or striding renal tumors compared to the approach suggested by conventional CTA.
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Shao
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Pu
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Cao
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Ju
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Qin
authors.affiliation: Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: changjunyin@hotmail.com.
authors.forename: Changjun
authors.initials: C
authors.lastname: Yin
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D015331:Cohort Studies; D003250:Constriction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D010690:Phlebography / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014567:Urography / Q000379:methods