Vascular anatomical variants in renal surgery: classic and robotic approach

Introduction and Objectives: Conservative renal surgery is based on the nephron-sparing principle. Renal arterial vascularization is of terminal type and the occlusion of an artery generates the necrosis of the corresponding region. The aim of this research is to analyze the anatomic particularities of the renal vascular system as they are highlighted in the course of standard and robotic surgeries. Patients and Methods: Between May 2006 and November 2010 we have performed 35 partial nephrectomies out of which 30 cases (85.7%) were performed by standard surgical approach and the other five (14%) were robot-assisted. In the same interval, we have done 103 pyeloplasties to obstruct the pyeloureteral junction: 65 (63%) were carried through by standard surgical approach, 32 (31%) by laparoscopic approach and six cases (6%) were robot-assisted. Results and Discussion: In 20 (54.3%) of cases, nine (25.7%) had two renal arteries (both superior and inferior), five (14.2%) had early ramifications of the renal artery outside the renal sinus, four (11.4%) patients showed two renal veins, one patient lacked the prepyelic venous plane, and in one patient we have found duplicate abdominal vena cava. Out of all the pyeloplasty cases, 31 (30%) showed an obstruction of the renal collecting system by crossing with a segmental artery or with a vein. Conclusions: Efficient renal surgery implies good knowledge of anatomical particularities of the renal vascular. The minimally invasive approach by robotic laparoscopy remains an essential coordinate in renal surgery and allows an efficient preparing of the vascular capital.