NEPHRON-SPARING SURGERY FOR RENAL-CELL CA RCINOMA IN THE UPPER POLE -ANATOMICAL BASIS

On the basis of their importance for nephron-sparing surgery in tumors of the superior pole of the kidney, we analyzed 3-dimensional endocas ts of the intrarenal structures. In 86.6 % the superior pole was relat ed to 3 arteries involved in its resection. Management of the superior (apical) segmental artery is in general simple as well as the ligatur e of the artery related to the anterior surface of the upper infundibu lum. Ligature of the branch of the posterior segmental artery, that is related to the upper infundibulum, is critical due to the risk of inj uring this segmental artery with loss of a great portion of renal pare nchyma. The posterior segmental artery (retropelvic artery) is involve d and must be preserved in all cases of superior pole resection. A ret ropelvic vein with its upper dorsal plexus was present in 69 % of the cases. This vein must be previously ligated to provided safe managemen t of the arteries during superior pole resection.