CT appearances following laparoscopic partial nephrectomy for renal cell carcinoma using a rolled cellulose bolster

Abstract

Purpose: To describe the evolving computed tomography (CT) appearances of a cellulose surgical bolster used as a hemostatic agent in patients who undergo laparoscopic partial nephrectomy for renal cell carcinoma. Materials and methods: We retrospectively reviewed the follow-up CT studies of 33 patients with stage T1N0M0 renal carcinoma who underwent laparoscopic partial nephrectomy using a rolled, oxidized, regenerated cellulose sheet sutured in place as a bolster in the parenchymal defect. Thirteen patients undergoing laparoscopic partial nephrectomy without the use of a bolster were also evaluated to differentiate imaging features. Results: The bolster-related masses were significantly larger than those seen in the non-bolster patients. There was a decrease in size of the post-operative bolster-related mass with time. The bolster shape evolved with time, initially appearing oval, and becoming irregular with decreasing size. Equivocal increase in attenuation of 10–20 HU was seen in 6 patients. Increase in attenuation of greater than 20 HU was seen in 3 patients. There was no evidence of tumor recurrence in any of the patients. Invagination of fat was seen in two bolster-related masses at 18 months or greater. Conclusions: Cellulose bolster has a variable appearance on follow-up CT exams. Evolutionary features include reduction in bolster size and shape with time leading finally to non-visualization. Bolster enhancement can mimic abscesses and tumor recurrence.

Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy

“…Presence of bolsteroma as an artifact has been reported up to 18 months and beyond. [ 11 ] The evolution of the shape of the artifact has also been described from oval to irregular to fibrotic scar. [ 11 ]…”

CT Appearance Following Partial Nephrectomy for Renal Cell Carcinoma Using Tissue Adhesive Bioglue

“…The differential diagnosis of renal masses following NSS is wide, Lee et al [20] in a comprehensive paper described a wide variety of post-operative changes. Pai et al [21] described the CT finding in the kidney following NSS using cellulose bolsters. Searching the medical literature we have not found a paper describing the changes following the use of BG, as the use of this material rapidly growth we thought it will beneficial for the clinicians to be familiar with its radiological characteristic in order to differentiate between normal post-operative features and those of tumor recurrence.…”

Computed tomography after nephron-sparing surgery

“…Examples are TachoSil Ò , an absorbable fibrin sealant patch, Glubran Ò , synthetic surgical glue, Tabotamp Ò , an oxidized regenerated cellulose patch, and FloSeal Ò , a thrombincoated gelatin matrix. It must be noted that in early postoperative imaging hemostatic sponges may appear as rim-enhancing lesions that could be mistaken for abscess or tumor recurrence [7]. Other high attenuation surgical materials, which are occasionally found in postoperative imaging, are vascular clips and embolization coils (Figs.…”

“…2A, B). Sometimes parenchymal defects are closed with bolsters of bioabsorbable agents which can induce foreign body reaction and form granulomas mimicking tumor residual [7].…”