What is the anatomy of the kidney, in relation relevant to partial nephrectomy nephron-sparing surgery (NSS)?

Updated: Apr 01, 2019
  • Author: Reza Ghavamian, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The vascular supply of the kidney is an important consideration for partial nephrectomy. The arterial anatomy supplies 4 distinct renal segments, including apical, inferior, posterior, and basilar segments. The number of arterial branches varies, especially the segmental arteries, all of which are end arteries. The renal artery typically divides into 4 or more segmental branches. The first segmental division is the posterior branch, which exits the main renal artery before it enters the renal hilum. The 4 anterior segmental vessels are, from superior to inferior, the apical, upper, middle, and lower anterior segmental arteries. The segmental arteries branch into lobar arteries, which branch again to form the interlobar arteries.

The venous anatomy differs on each side and differs from the arterial supply. Venous branches within each segment form a fine anastomosing network that allows for liberal venous ligation within the parenchyma at the time of nephron-sparing surgery (NSS), with little worry about segmental infarction. Small venous branches can be ligated to allow mobilization and retraction of the major renal veins and the segmental veins at the hilum for exposure. The left renal vein is longer. It branches into a lumbar, adrenal, and gonadal vein before entering the renal sinus. The right renal vein has no significant collaterals. The adrenal and gonadal veins that drain straight into the inferior vena cava are an important consideration in renal surgery.

At the renal hilum, the renal vein lies most anteriorly, and the artery lies behind it. Both the vein and the artery lie anterior to the renal pelvis.


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