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Insights into Imaging
Published in: Insights into Imaging 4/2015

Open Access 01-08-2015 | Pictorial Review

Multidetector CT imaging of complications after laparoscopic nephron-sparing surgery

Authors: Massimo Tonolini, Anna Maria Ierardi, Virginia Varca, Giacomo Piero Incarbone, Marina Petullà, Roberto Bianco

Published in: Insights into Imaging | Issue 4/2015

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Abstract

Purpose

Laparoscopic nephron-sparing surgery (L-NSS) is increasingly performed to treat localised renal lesions. However, the associated morbidity is non-negligible, with a rate of major complications approaching 10 %.

Methods and Results

This paper provides an overview of indications, surgical techniques and results of L-NSS; explains the incidence, risk factors and manifestations of postoperative complications; discusses the preferred multidetector computed tomography (CT) acquisition techniques; illustrates the appearance of normal postoperative images following L-NSS; and reviews, with example images, the most common and unusual iatrogenic complications. These include haematuria, haemorrhage, vascular injuries, infections and urinary leaks. Most emphasis is placed on CT, which provides rapid, reliable triage and follow-up of iatrogenic complications after L-NSS, identifying occurrences that require transarterial embolisation or repeated surgery.

Conclusions

Multidetector CT allows precise assessment of the surgical resection site; detection of pneumoperitoneum and subcutaneous emphysema; quantification of retroperitoneal blood; and identification of active bleeding, pseudoaneurysms, arterio-venous fistulas, abscess collections and extravasated urine.

Teaching Points

• Laparoscopic nephron-sparing surgery (NSS) is increasingly performed to treat renal lesions.
• Radiologists are increasingly requested to investigate suspected post-surgical NSS complications.
• Post-NSS complications include haemorrhage, haematuria, vascular injuries, infections and urinary leaks.
• Multidetector CT allows choice between conservative treatment, transarterial embolisation or surgery.
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Metadata
Title
Multidetector CT imaging of complications after laparoscopic nephron-sparing surgery
Authors
Massimo Tonolini
Anna Maria Ierardi
Virginia Varca
Giacomo Piero Incarbone
Marina Petullà
Roberto Bianco
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 4/2015
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-015-0413-1

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