Role of CT angiography in the preoperative evaluation for laparoscopic nephrectomy

Laparoscopic nephrectomy (LN) was recently introduced as a minimally invasive alternative to open nephrectomy in living related renal donation. Because of the limited field of view available with laparoscopic techniques, the role of preoperative radiologic evaluation in LN has expanded to include anatomic definition of the renal arteries, collecting system, renal parenchyma, and renal venous anatomy. Computed tomographic (CT) angiography has proved to be a minimally invasive alternative to conventional angiography in the preoperative evaluation of living related renal donors. CT angiography has been shown to have an accuracy comparable to that of conventional angiography in predicting renal arterial anatomy. In addition, CT angiography provides comprehensive definition of the renal vascular anatomy including the location, size, and length of the renal, adrenal, gonadal, and lumbar veins. Dual-phase spiral CT combined with three-dimensional CT angiography constitute a single, minimally invasive procedure that can provide a complete preoperative evaluation of potential living related renal donors prior to LN. Comprehensive anatomic depiction of the renal arterial and venous supplies aids in surgical planning and helps avoid potential complications.