Imaging

Abstract

Objectives: Artery-only occlusion (AO) has been used during nephron-sparing surgery to reduce ischemic damage. However, this has not been demonstrated in laparoscopic partial nephrectomy (LPN). We compared our experience with AO and both artery and vein occlusion (AV) in LPN to optimize the method of ischemia. Methods: This retrospective case-control study identified 25 patients who underwent AO during LPN and matched them to a cohort of 53 patients who underwent LPN with AV. The groups were compared for ischemia time, blood loss, transfusion rate, and renal function. Results: The 2 cohorts were comparable on demographic data. Blood loss was similar, with AO and AV demonstrating equivalent transfusion rates. The 2 cohorts had similar warm ischemia times. Positive margin rate was not affected by venous backflow in the AO cohort (0% AO vs 1.9% AV, P = .679). No significant postoperative change in creatinine (Cr) or creatinine clearance (CrCl) was seen for AO; however, a significant change in Cr and CrCl was seen in AV. Conclusions: AO during LPN does not lead to a greater blood loss or an increased warm ischemia time. The benefit of AO on renal function is significant and requires further investigation. Editorial CommentLaparoscopic partial nephrectomy has evolved due to better laparoscopic instruments, high volume surgeons and institutions. Renal warm-Ischemia reperfusion injury remains a very controversial and complex issue without many answers. From optimal ischemia time to ameliorate injury to ideal temperature for renal cooling to preserve renal function are still big question marks. The idea of arterial clamping only allowing venous back flow leakage may cause less visualization and more bleeding but protective mechanism for warmIschemia reperfusion injury may be related to the possibility of leakage of adhesion molecules or oxygen radical scavengers that may cause protection but these issues need future investigation. Dr. Fernando J. KimChief of Urology, Denver Health Med Ctr Assistant Professor, Univ Colorado Health Sci Ctr Denver, Colorado, USA E-mail: fernando.kim@uchsc.edu Roentgenol. 2008; 191: 1545-51 Objective: The purpose of this retrospective study was to determine the sensitivity and specificity of combined PET/CT in differentiating benign from malignant adrenal nodules measuring at least 1 cm in diameter in patients with cancer. IMAGING ______________________________________________________________________ Utility of PET/CT in differentiating benign from malignant adrenal nodules in patients with cancer