Evaluation of prospective living renal donors for laparoscopic nephrectomywith multisection CT: The marriage of minimally invasive imaging with minimally invasive surgery

Laparoscopic technique for excision of a kidney from a living donor has adv antages over conventional open surgery, but operative visibility and surgic al exposure are limited. Preoperative multisection computed tomography (CT) can provide necessary anatomic information in a minimally invasive procedu re. A three-phase examination is suggested: (a) imaging from the top of the kidneys to the pubic symphysis with a section width of 2.5 mm and no contr ast medium, (b) scanning of the kidneys and upper pelvis during the arteria l phase of enhancement with a section width of 1.0 mm, and (c) scanning of the kidneys and upper retroperitoneum during the nephrographic phase of enh ancement with a section width of 1.0 mm. Emphasis in this article is placed on analysis of the venous anatomy because most radiologists are unfamiliar with the anatomic variations. Conventional radiography of the abdomen and pelvis is performed after CT to evaluate the collecting system and ureters and to provide a lower total radiation dose than if CT were used. Of severa l postprocessing techniques that may be used, the authors prefer maximum in tensity projection for arterial evaluation and multiplanar reformatting for venous evaluation.