How is the vasculature of the kidney and the tumor assessed in the preoperative workup for 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

Although not essential in small peripherally located tumors, preoperative evaluation of the vasculature of the kidney and the tumor can aid in tumor excision. This is especially true of larger lesions and those that occupy a more central position close to the renal hilum, especially in a solitary kidney. In the past, renal angiography was used routinely to delineate vasculature. In the modern era, less invasive modalities, such as MRA, can be used to define anatomic relationships preoperatively.

In addition, the use of 3-dimensional helical CT scan has provided important anatomical information concerning the renal vasculature and excretory function of the affected kidney. This technique better defines the relationship of the tumor with the collecting system and renal vasculature for preoperative surgical planning. In addition, it helps to anticipate tumor extension further so that operative complications can be minimized while obtaining the maximum surgical outcome. Small cuts through the tumor can be generated and the 3-dimensional reconstruction can aid in the surgical planning.


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