Three-dimensional renal CT angiography for guiding segmental renal artery clamping during laparoscopic partial nephrectomy

Xu, Yi; Shao, Pengfei; Zhu, Xiaomei; Lv, Qiang; Liu, Wangyan; Xu, Hai; Zhu, Yinsu; Yang, Guangyu; Tang, Lijun; Chen, Yin

doi:10.1016/j.crad.2013.06.002

Cited by 26 publications

(7 citation statements)

References 20 publications

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“…As WIT in our cohort tended to be well below Thompson's 25‐min threshold , we are unable to comment on any theoretical advantage of SAC in patients with extended WIT. The use of advanced imaging and RENAL nephrometry score interpretation can help predict extended WIT preoperatively and the patients to which these findings would not apply . In particular, the strong positive correlation between the ‘radius’, ‘endophytic/exophytic’, and ‘nearness to collecting system’ components of the RENAL nephrometry score and WIT allows accurate prediction of the relative complexity of patients’ cases, and ultimately WIT.…”

Section: Discussionmentioning

confidence: 99%

Selective arterial clamping does not improve outcomes in robot‐assisted partial nephrectomy: a propensity‐score analysis of patients without impaired renal function

et al. 2016

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Our study findings show no difference in PSM rates, complication rates or intermediate-term renal functional outcomes between patients with unimpaired renal function who underwent SAC vs those who underwent MAC. When expected WIT is low, the routine use of SAC may not be necessary. Further studies will need to determine the role of SAC in patients with a solitary kidney or with significantly impaired renal function.

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Section: Discussionmentioning

confidence: 99%

Selective arterial clamping does not improve outcomes in robot‐assisted partial nephrectomy: a propensity‐score analysis of patients without impaired renal function

et al. 2016

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“…Gill et al [9] published a novel approach in 2011 that involved microdissection of vessels of the renal hilum into the parenchyma and clamping of the tumor-feeding artery to retain renal function after PN. 1.2-mm slice, dual-source CT angiography with 3D reconstruction has been used to identify tumor-feeding segmental arteries precisely [10]. To verify the selectivity of regional ischemia, intraoperative color Doppler ultrasound, or ICG plus near-infrared fluorescence (NIRF) can be performed [11].…”

Section: Introductionmentioning

confidence: 99%

Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

Wang¹,

Zhang³

et al. 2014

Urol Int

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Objective: To analyze current evidence comparing the safety and outcomes of regional and global ischemia for partial nephrectomy (PN). Materials and Methods: A systematic search of the PubMed and Web of Science databases was conducted in May 2014 to identify studies comparing the safety and outcomes of regional and global ischemia for PN. A systematic review and meta-analysis was also performed. Results: Six retrospective observational studies were selected for the analysis, including 363 patients who underwent PN (162 regional ischemia and 201 global ischemia cases). Operation times were not statistically different [weighted mean difference (WMD) = 20.35 min, 95% CI: -0.28-40.97, p = 0.05], but estimated blood loss was significantly higher in the regional ischemia group (WMD = 52.04 ml, 95% CI: 14.30-89.78, p = 0.007) than in the global ischemia group. Complication rates [odds ratio (OR) = 1.16; 95% CI: 0.63-2.15, p = 0.63] and blood transfusion rates (OR = 1.85; 95% CI: 0.86-4.01, p = 0.12) of the two groups were not significantly different. The regional ischemia group showed better postoperative renal function (WMD = 4.23 ml/min, 95% CI: 2.61-5.85, p < 0.00001) than the global ischemia group, and all cases in the regional ischemia group showed negative margins. Conclusions: Regional ischemia is as safe to perform as global ischemia, and the former leads to better postoperative renal functions than the latter. These findings support the application of regional ischemia for PN.

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“…Therefore, measurement of split and total GFR without renal tumor preoperatively needs further investigation. CT scan is routinely performed preoperatively to describe anatomy of vascular, kidney parenchymal, and tumor (Miles, 2003), especially for precise segmental artery clamping in laparoscopic partial nephrectomy (Xu et al, 2013). On CT enhancement scan, the injected iodinated contrast medium is not reabsorbed nor excreted at the renal tubules, which is the same as inulin clearance (Svaland et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

Measurement of Glomerular Filtration Rate Using Multiphasic Computed Tomography in Patients With Unilateral Renal Tumors: A Feasibility Study

Wang

Liu

et al. 2019

Front. Physiol.

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ObjectivesThis study was to assess the feasibility of a modified multiphasic CT scan protocol combined with homemade software measurements of glomerular filtration rate (CT-GFR) and explore the effect of renal tumor volume on the calculation of CT-GFR.Materials and MethodsProspective observational study comparing three methods of GFR measurement from February 2017 to December 2017, 91 patients with unilateral renal tumor underwent both a modified multiphasic CT scans of kidney and serum creatinine (Scr) tests preoperatively, of which 15 cases underwent additional radionuclide examination. Total and split CT-GFR, with or without renal tumor, were quantified by the homemade software in early and late renal parenchymal phases, respectively. The volume of renal tumor was quantified by the homemade software. Correlation and difference between CT-GFR and traditional methods of GFR measurement, including estimated GFR (eGFR) from Scr concentration and split GFR using of radionuclide examination (R-GFR), were performed.ResultsThere is a strong correlation between CT-GFR with renal tumor and eGFR (r = 0.90, p < 0.001) in early renal parenchymal phase. The relative CT-GFR in early renal parenchymal phase was highly correlated with the relative R-GFR (r = 0.88, p < 0.001). Renal tumor volume significantly correlated with the value of CT-GFR that determined by subtracting the CT-GFR measurement without renal tumor from CT-GFR measurement with renal tumor (r = 0.89, p < 0.001).ConclusionA modified multiphasic CT scan protocol combined with homemade software might be an alternative technique for the evaluation of renal function for the patients with unilateral renal tumor.

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Three-dimensional renal CT angiography for guiding segmental renal artery clamping during laparoscopic partial nephrectomy

Cited by 26 publications

References 20 publications

Selective arterial clamping does not improve outcomes in robot‐assisted partial nephrectomy: a propensity‐score analysis of patients without impaired renal function

Selective arterial clamping does not improve outcomes in robot‐assisted partial nephrectomy: a propensity‐score analysis of patients without impaired renal function

Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

Measurement of Glomerular Filtration Rate Using Multiphasic Computed Tomography in Patients With Unilateral Renal Tumors: A Feasibility Study

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