Features of intravital renal topography in various patient’s positions on the basis of multislice computed tomography findings

Abstract

The aim of the study is to investigate changes in the renal topography in the supine and lateral position of the patient in order to further improve the preoperative planning of laparoscopic operations in kidney masses.

Material and methods. The study included 35 patients with a simple renal cyst, who underwent computed tomography in the supine position and on the healthy side (operating position). To assess the topography, the authors have proposed the following coordinate system: on axial computed tomograms performed with the patient in the supine and lateral position, the OY axis was drawn across the spinous process and the middle of the vertebral body, the OX axis was perpendicular, and went across the most posterior point of the spinal foramen. CT-grams were assessed using RadiAnt DICOM Viewer program.

Results. The study defined morphometric features of the renal displacement medially and anteriorly, as well as cranially or caudally. There was a greater mobility of the left kidney compared with the right kidney. The least mobile was the upper third of the kidney on each side, the middle third of the kidney was more mobile at the level of the hilum, and the greatest displacement was noted in the lower third of the kidney. When patients being in the lateral position, the left kidney was more often displaced downward (caudally) – in 83% of cases, the right kidney was equally often displaced cranially (53% of cases) and caudally - 47%. In all cases of the patient's lateral position, the displacement of the kidney was accompanied by deformation of its vascular pedicle.

Conclusion. The data obtained must be taken into account in preoperative planning, when performing laparoscopic kidney surgery.