Electromedia 69 (2001) No. 1
Coll D.M., Davros W.J., Novick A.C., Wirth S., Herts B.R.
Nephron Sparing Surgery (NSS) is the preferred treatment option for patients who have a renal tumor and a solitary kidney, contralateral renal abnormalities or renal insufficiency from any cause. Total nephrectomy in many or all of these cases would render the patient anephric and on dialysis, which has its own attendant risks. Since studies have shown similar success rates between NSS as compared to radical nephrectomy for treating renal cell carcinoma in select subgroups of patients with low-stage, low grade neoplasms, NSS for renal tumors has become more widespread [1].
The surgical techniques for NSS are more demanding than those for total or radical nephrectomy and require a detailed understanding of the renal vascular and collecting system anatomy. Accordingly, since renal vascular and collecting system anatomy are widely variable, preoperative imaging is needed for surgical planning. The purpose of this study is to demonstrate how 3D volume rendering techniques are used to assist in the planning of NSS.
The preoperative evaluation of patients before NSS includes CT with or without conventional angiography. Angiography may be necessary to delineate the arterial supply to the kidney, which consists of end vessels and little or no collateral blow flow between the four major segments. Ligation of segmental vessels not supplying the tumor would result in renal infarction and loss of normal parenchyma. This is not true for litigation of small peripheral vessels. For this reason angiography is typically performed for large or central tumors but not for small peripheral lesions.