Morphometric study of extra-hepatic biliary pathways: study in human corpses / Estudio morfométrico de las vías biliares extrahepáticas: estudio en cadáveres humanos

SUMMARY: Adverse events (AE) contribute significantly to postoperative morbidities and comorbidities. Many AEs occur due to a lack of anatomical knowledge and its variants. Latrogenic bile duct injuries, for instance, represent a serious surgical complication of laparoscopic cholecystectomy. Anatomical knowledge for the identification and adequate drainage of all ducts is relevant and fundamental in order to avoid future errors. The objective of the study was to morphometrically analyze the bile ducts in adult human corpses. 13 livers were extracted from adult human corpses to obtain the ducts: choledochal, common hepatic and cystic. After morphological analysis, duct measurements (length and diameter) were continued using a digital caliper. The data obtained were tabulated in SPSS 21 program, performing descriptive analysis with mean and standard deviation. The averages of bile ducts were 61.05 (± 16.43) mm in length and 3.86 (± 0.72) mm in diameter. The cystic duct length and diameter averages were 33.59 (± 12.29) mm and 3.40 (± 0.79) mm, respectively. The common hepatic ducts had an average of 30.02 (± 7.19) mm in length and 3.74 (± 1.18) mm in diameter. The analyzed samples presented different values ?? from those already described in the literature, where the length of the cystic ducts was greater, while the length of the common hepatic ducts was numerically smaller. This work is very significant, as the morphometric variability of the bile ducts allows for varying morphological situations that can compromise the hepatobiliar physiology.

RESUMEN: Los eventos adversos (EA) contribuyen significativamente a las morbilidades y comorbilidades postoperatorias. Muchos EA se deben a la falta de conocimiento de la anatomía y sus variaciones. Por ejemplo, las lesiones iatrogénicas de las vías biliares representan una complicación quirúrgica grave de la colecistectomía laparoscópica. El conocimiento anatómico para la identificación y drenaje adecuado de todos los conductos es relevante y fundamental para evitar futuros errores. El objetivo del estudio fue analizar morfométricamente las vías biliares en cadáveres humanos adultos. Se extrajeron 13 hígados de cadáveres humanos adultos y se retiraron los conductos: colédoco, hepático común y cístico. Después del análisis morfológico, se continuó con las mediciones de los conductos (longitud y diámetro) utilizando un calibrador digital. Los datos fueron tabulados en el programa SPSS 21, mediante análisis descriptivos con media y desviación estándar. Los promedios de las vías biliares fueron de 61,05 (± 16,43) mm de longitud y 3,86 (± 0,72) mm de diámetro. Los promedios de longitud y diámetro del conducto cístico fueron 33,59 (± 12,29) mm y 3,40 (± 0,79) mm, respectivamente. Los conductos hepáticos comunes tenían un promedio de 30,02 (± 7,19) mm de longitud y 3,74 (± 1,18) mm de diámetro. Las muestras analizadas presentaron valores diferentes a los ya descritos en la literatura, donde la longitud de los conductos císticos era mayor, mientras que la longitud de los conductos hepáticos comunes fue numéricamente menor. Este trabajo es significativo, debido a que la variabilidad morfométrica de las vías biliares y permite identificar situaciones morfológicas que pueden comprometer la fisiología hapatobiliar.

Anatomical And Embryological Study Of Renal Hilum

Introduction: As per standard text, the anteroposterior topographical arrangement of renal hilar structures are:vein-artery-renal pelvis. However, hilar variations are very common. Aim: The present study intends to increaseawareness of possible variations in the hilar anatomy as they are of immense importance in invasive renalinterventions.Materials and methods: A careful dissection of 51 embalmed cadaveric kidneys was carried out for the propervisualization of renal hilar structures and their relations were clearly defined.Observations and Results: Enormous renal hilar variation was observed. We classified these renal variations in8 different patterns. Normal hilar arrangement was seen in 25.5% kidneys and in 74.5% cases this arrangementis disturbed. 43.1% kidneys demonstrated presence of retropelvic structures. Anterior and posterior tributariesof renal vein were displayed in 9.8% of casesConclusion: Knowledge of the pattern of renal hilar structures is of great importance in the interventionalradiological & laparoscopic renal surgeries thereby reducing the risk of vascular complications.

Variação morfológica no padrão lobar e nas fissuras dos pulmões: relato de caso / Morphological variation in the lobar pattern and in the fissures of the lungs: a case report

Modelo do estudo: Relato de caso. Importância do problema: Lobos e fissuras acessórias nos pulmões podem induzir a erros de interpretação e diagnóstico, além de favorecer a disseminação de patologias como a pneumonia para lobos adjacentes. Dessa forma, a constatação dessas alterações anatômicas pode colaborar em diagnósticos clínicos e procedimentos cirúrgicos. Comentários: Relatamos um caso raro de modificação anatômica nos lobos e fis-suras dos pulmões. O pulmão esquerdo exibia um lobo médio acessório e uma fissura horizontal completa. Por outro lado, o pulmão direito apresentava duas fissuras acessórias incompletas situadas inferiormente na face costal do lobo médio. Além disso, observamos que o hilo do pulmão esquerdo continha dois brônquios lobares (superior e inferior), um brônquio lobar acessório e três artérias pulmonares. O conhecimento das variações anatômicas aqui relatadas é fundamental, pois auxiliam os profissionais da saúde nos diagnósticos e nas decisões terapêuticas e cirúrgicas.(AU)

Study: Case Report. Importance: Lobos and accessory fissures in the lungs can induce errors of interpretation and diagnosis, as well as favor the spread of pathologies such as pneumonia to adjacent lobes. Thus, the confirmation of these anatomical alterations can collaborate in clinical diagnoses and surgical procedures. Comments: We report a rare case of anatomical variation in the lobes and fissures of the lungs. The left lung showed an accessory middle lobe and a complete horizontal fissure. On the other hand, the right lung had two incomplete accessory fissures located inferiorly in the costal face of the middle lobe. In addition, we observed that the left lung hilum contained two lobar bronchi (upper and lower), one accessory lobar bronchus and three pulmonary arteries. Knowledge of the anatomical variations reported here is fundamental, as they help health professionals in diagnoses and therapeutic and surgical decisions (AU)

Morphological Study Of Human Lungs

Background and aims: Knowledge of anatomical variations in lung morphology is not only of academic interestbut is essential during surgery and also while interpreting various radiological images. The present study wasundertaken with the aim to observe the variations of lung morphology.Materials and Methods: The shape of the lungs, variations of fissures, lobes and hilar structures were studied in42 right and 37 left isolated lungs.Results: Unusual shape was seen in 4 lungs. Among the right lungs, oblique fissure was incomplete in 42.86% andabsent in 7.14% and horizontal fissure was incomplete in 61.90% and absent in 19.05%. Inferior accessoryfissure (IAF) was present in 21.43% and superior accessory fissure (SAF) in 7.14%. Usual right hilar architecturehaving a pulmonary artery with 2 pulmonary veins and 2 bronchi was not seen in any case however, the usualarchitecture with a superior lobar artery was seen in 28.57% cases. Among the left lungs, oblique fissure wasincomplete in 40.54% and absent in 2.70%. Horizontal fissure was present in 24.32%, left minor fissure (LMF) in29.73%, inferior accessory fissure (IAF) in 43.24% and superior accessory fissure (SAF) in 2.70%. Usual left hilararchitecture having a pulmonary artery, 2 pulmonary veins and a bronchus was seen in 54.06%.Conclusion: The knowledge of variations in the lung morphology observed in this study will be of academicinterest and also useful for diagnostic and clinical management of pulmonary and even cardiac cases

Morphological Study Of Lobes, Fissures And Pulmonary Hilar Structures

Introduction: The organs of respiration, a pair of lungs, are present in the thorax one in each side of themediastinum. The right lung has two fissures – oblique and horizontal, and the left lung has a single obliquefissure. The division of the lung into different lobes by the fissures helps in the relative movement of the lobeswith respect to one another, thereby contributing to the uniform expansion of the lung. Variations are seen in thenumber and pattern of fissures, as well as the number and arrangement of hilar structures. Knowledge of thenormal morphology of the lung as well as the common variations are essential prerequisites for radiologists,pulmonologists and surgeons.Materials and methods: The variations in the number of fissures, lobes, and arrangement of hilar structures werestudied in the right and left lungs of 25 formalin fixed cadavers at Sree Mookambika Institute of MedicalSciences, Kulasekharam.Results: Left lungs - one lung (4%) had two fissures and three lobes. Hilar structures were normal in number andarrangement. Right lungs - Number and pattern of fissures and lobes were normal in all the specimens. Six lungs(24%) had variations in hilar structures with 4 (16%) of them having a single bronchus, two lungs (8%) havingthree pulmonary veins and one lung (4%) having the atypical arrangement of hilar structures in which thebronchus and pulmonary artery at the same level.Conclusion: Prior anatomical knowledge and possible variations in the number of fissures, lobes, and arrangementof hilar structures, which may be regionally different and are essential prerequisites for clinicians, radiologistsand surgeons

A Cadaveric Study On Morphological Variations Of Lobar And Hilar Anatomy Of Human Lungs

Background: Knowledge of variations in fissures and hilar structures of the lungs is necessary for the appreciationof lobar anatomy and hilar anatomy of lungs.Materials and Methods: Morphological variations of fissures, lobar and hilar structures were studied in 50formalin fixed lungs belonged to 40-80 years age group.Results: In the present study following observation was made: Right sided lungs had, Incomplete Horizontalfissures in 7 lungs, absent horizontal fissures in 2 lungs, among Hilar structures 2 arteries in 5 lungs, 3 veinsin 2 lungs, 1 bronchus in 2 lungs. Left sided lungs had, Incomplete horizontal fissures in 2 lungs, among hilarstructures, 1 vein in 2 lungs, 3 vein in 2 lungs and 2 bronchus in 7 lungs.Conclusion: Awareness regarding variations in fissures, lobes and hilar anatomy of the lungs is importantclinically while interpreting the radiological images as well as to plan various surgical procedures to avoidpostoperative complications.

Treatment of gallbladder carcinoma invading porta hepatis with the conventional surgery approach and the transhepatic hilar approach: A retrospective comparative study / 中国实用外科杂志

OBJECTIVE: To evaluate the clinical efficacy of transhepatic hilar approach exposing porta hepatis for the treatment of gallbladder carcinoma invading porta hepatis. METHODS: The clinicopathological data of patients with gallbladder carcinoma invading porta hepatis who underwent surgical treatment at Department of General Surgery and Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2007 to December 2017 was collected. There were 39 patients enrolled in the study, including 19 patients in the conventional surgical approach group and 20 patients in the transhepatic hilar approach group. The R0 resection, intraoperative bleeding, postoperative complications and overall survival time were compared between the conventional approach group and the transhepatic hilar approach group. RESULTS: CT and/or MRI were used for preoperative evaluation in the conventional approach group, and CT + MRI + 3 D reconstruction were used in the transhepatic hilar approach group.The accuracy rate of preoperative resectable evaluation was 57.9%(11/19) in the conventional approach group, and 90.0%(18/20) in the transhepatic hilar approach group(P=0.031). The R0 resection rate of the conventional approach group was 26.3%(5/19), while the R0 resection rate of transhepatic hilar approach group was 85.0%(17/20)(P=0.000). The operations of the conventional approach group and the transhepatic hilar approach group were shown as follow: S4 b,5 + extrahepatic bile duct (7/8), S4 b,5,6,7,8 + extrahepatic bile duct (3/6), S4 a,4 b,5,6,7,8 +extrahepatic bile duct (0/1), extended resection(1/3) and others (8/2)(P= 0.156). The number of death within 30 days after surgery in the conventional approach group and the transhepatic hilar approach group was 4 and 0 respectively (P=0.047). Among the hepatectomy patients, the blood loss in the conventional approach group was significantly higher than that in the transhepatic hilar approach group [(660 ± 219.1)mL vs.(358.8 ± 184.8)m L,P=0.006]. The postoperative complication rate of Clavien Ⅲ to Clavien Ⅴwas significantly higher in the conventional approach group [Clavien Ⅲ was72.7% vs. 27.8% (P=0.027), Clavien Ⅳ was 45.5% vs. 0 (P=0.004), and Clavien Ⅴ was 27.3% vs. 0(P=0.045)]. The 1-year survival rate of the conventional approach group and the transhepatic hilar approach group was 21.1%(4/19) and61.1%(11/18)(P=0.020), respectively. The overall survival time of the transhepatic hilar approach group was significantly better than that of the conventional approach group(16.0 months vs. 8.4 months, P=0.0005). CONCLUSION: The transhepatic hilar approach can improve the R0 resection rate, reduce intraoperative blood loss, perioperative mortality and serious complication rate, and improve the overall survival time. CT+MRI+3 D reconstruction can improve the accuracy of preoperative resectable evaluation and reduce unnecessary surgical exploration.

Application of perihilar surgical techniques in intrahepatic cholangiocarcinoma invading hepatic hilum / 中国实用外科杂志

Intrahepatic cholangiocarcinoma invading hepatic hilum has the biological characteristics and clinical features of both gallbladder cancer and hilar cholangiocarcinoma, and it also combines the pathophysiological changes of liver disease.There are a series of therapeutic difficulties such as difficult exposure of three hepatic hilum, complexity of liver resection,difficult treatment of combined liver diseases and insensitivity to radiotherapy and chemotherapy, which result in low radical resection rate, difficulty in operation, high operative risk and poor prognosis. The perihilar surgical technique system based on special clinical features, surgical methods and pathophysiological characteristics, evaluates the tumor resectability, the anatomy structure of three hepatic hilum and the reserved liver function comprehensively and accurately before surgery, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, combined with accurate liver resection, accurate and high-quality biliary anastomosis and management of postoperative complication,which can improve surgical radicalization and safety, reduce surgical risk and postoperative complication rate, thereby improve the overall survival time of patients.

Application of perihilar surgical techniques in gallbladder cancer invading hepatic hilum / 中国实用外科杂志

Gallbladder cancer invading hepatic hilum has both the biological characteristics of gallbladder cancer and the clinical features of hilar cholangiocarcinoma. There are a series of therapeutic difficulties such as difficult exposure of hepatic hilum, multiple organ resection, resection and reconstruction of hilar vessels, complex cholangiojejunostomy and liver functional restriction, which result in low radical resection rate, difficulty in operation, high operative risk, more postoperative complications and perioperative mortality. The perihiliar surgical technique system adopts accurate preoperative three-dimensional imaging evaluation and liver function evaluation, and completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, which is beneficial to intraoperative re-evaluation. It can improve the R0 resection rate, quality of vascular resection and reconstruction, quality of cholangiojejunostomy, and reduce perioperative morbidity and mortality. Surgeons should pay attention to the combination of perihiliar surgical technique and oncology in order to screen which patients will benefit from operation.

Application of perihilar surgical techniques in biliary tract surgery / 中国实用外科杂志

Perihilar biliary diseases have a wide spectrum of diseases including stones, inflammation, tumors, injuries and congenital malformations. Because of their characteristics such as anatomic variability, pathophysiological complexity, high operative difficulties, more postoperative complications and high operative risk, the perihilar biliary surgery is a high difficulty area in biliary surgery. For common clinical features ,common surgical methods and common technical difficulties of perihilar biliary diseases, the perihilar surgical technique system adequately evaluates hilar anatomy and its variations,liver function and volume of residual liver relying on threedimensional digital medical imaging technology, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, then re-evaluates the relationship between the lesion and the hepatic artery and portal vein, and ultimately sets the surgical procedure . It is developed to improve the R0 resection rate, quality of cholangiojejunostomy, quality of vascular resection and reconstruction and safety of operation,eventually for the purpose of reducing postoperative complication rate and perioperative mortality and improving the prognosis. So surgeons should pay attention to the comprehensive system involving multiple disciplines in order to improve the effectiveness and safety in diagnosis and treatment of perihilar biliary diseases.

Squamous Cell Carcinoma of the Extrahepatic Common Hepatic Duct

We report a rare case of hilar squamous cell carcinoma. A 62-year-old Korean woman complaining of nausea was referred to our hospital. Her biliary computed tomography revealed a 28 mm-sized protruding solid mass in the proximal common bile duct. The patient underwent left hemihepatectomy with S1 segmentectomy and segmental excision of the common bile duct. Microscopically, the tumor was a moderately differentiated squamous cell carcinoma of the extrahepatic bile duct, without any component of adenocarcinoma or metaplastic portion in the biliary epithelium. Immunohistochemically, the tumor was positive for cytokeratin (CK) 5/6, CK19, p40, and p63. Squamous cell carcinoma of the extrahepatic bile duct is rare. To date, only 24 cases of biliary squamous cell carcinomas have been reported. Here, we provide a clinicopathologic review of previously reported extrahepatic bile duct squamous cell carcinomas.

Exploration and development of indocyanine green fluorescence applied in laparoscopic splenic hilum lymph node dissection for gastric cancer / 中华肿瘤杂志

With the continuous development of laparoscopic techniques and the concept of individualized treatment, laparoscopic surgery is also moving from "minimally invasive" to "minimally invasive plus precision" . Lymph node metastasis is one of the most important risk factors affecting the prognosis of gastric cancer (GC). Reasonable lymph node dissection has always been an important exploration direction in the field of GC surgery. In recent years, domestic and foreign studies have found that the new tracer, indocyanine green (ICG), can detect the lymphatic vasculature non-invasively, and more accurately display the perigastric lymph nodes, providing a new perspective in laparoscopic lymph node dissection for GC. Alternatively, since the application of ICG in laparoscopic gastrointestinal tumor surgery, especially in gastric cancer surgery is still in the early stage of exploration and experience accumulation, more high-level medical evidences are needed to evaluate its clinical value.

A Cadaveric Study Of Variations In The Urological System

Introduction: Knowledge of anatomical variations of the urinary system is important for urological surgeriesinvolving renal transplant and radiological interpretations. When urologists and clinicians have a soundknowledge of anatomical variations, it eases management, surgical interventions and helps to reducecomplications.Advanced imaging technology is the boon for the patients requiring minimally invasive approaches for variouskidney disorders. These approaches require precise knowledge of normal and variant anatomy of the kidneys,ureters and vascular structures at the hilum of the kidney. Therefore, the objective of this study was to furnish theclinicians with the major anatomical variations of urological system.Method: Ninety adult human cadavers were examined for number, shape and position of kidneys and the uretersover a period of 5 years. Out of these, 85 were males and 15 were female cadavers.Results: Kidneys were bilaterally present in all the cadavers. Hypoplastic kidneys were seen bilaterally in 3.3%cadavers. Out of 90 cadavers, 3 showed bilateral and 6 showed unilateral lobulated kidneys. 2 cadavers showedunilateral (1 L, 1 R) incomplete double ureter. One showed bilateral and 5 showed unilateral accessory renalartery amongst 90 cadavers. Ectopic kidney was seen in one cadaver.Conclusions: Morphological variations in the kidney are very common and are clinically important for urosurgeons

Anatomical Variations Of Branching Pattern Of Main Renal Artery In Hilum And Prehilar Area

The hila and adjacent pre-hilar parts of 72 kidneys (35 right and 37 left) isolated from formalin fixed cadaverswere examined. The hilum and prehilar area of each kidney was dissected to observe the total number ofbranches of the main renal artery. This information is useful in nephron sparing surgeries such as partialnephrectomy by laparoscopic approach. Subsequently, prehilar branching of the main renal artery before itenters the hilum was observed in 48.6% of kidneys with a higher incidence of 51.3% in left kidneys as comparedwith the incidence of the right side (45.7%). We further observe the variations of branching patterns in the mainrenal artery and calculate the incidences. Finally, our results are compared with that of similar studies conductedpreviously.

Study Of Arrangement Of Renal Hilar Structures In Human Cadavers

Background: Renal hilum is the middle concavity of the medial border of kidney which communicates with renalsinus. The disposition of renal hilar structures has been described in anatomical textbook from anterior toposterior as the renal vein, renal artery and renal pelvis. Variations in arrangement of renal hilar structureswere detected incidentally while performing investigative imaging and angiographic procedures. Anatomicalknowledge of structures at the renal hilum is of great importance for various urological surgical procedures andalso during interpretation of various radiological techniques related to the kidney.Objective: To evaluate the arrangement of renal hilar structures in human cadaversMaterials and Methods: Present work was carried out in the Department of Anatomy, Sri Devaraj Urs medicalcollege, Kolar on fifty pairs of morphological normal kidneys of embalmed cadavers. Renal hilum of each kidneywas dissected carefully to see the arrangement of renal artery, vein and pelvis and their anteroposterior relationsat the hilum were recorded.Results: The arrangement of renal hilar structures exhibited great variations. The patterns of arrangement of thehilar structures were classified into 12 major patterns. In 32 % kidney we observed the classical arrangement ofhilar structures described in standard textbooks as renal vein, renal artery and pelvis. In 36% cases anteriortrunk of renal artery is the most anteriorly placed structure at the renal hilum. In 21% cases we observed anteriorand posterior tributaries of renal vein. The renal pelvis in between the divisions of renal artery and tributariesof renal vein was noted in 43% cases. We noticed the formation of the renal pelvis outside the hilum in 7% cases.Conclusion: Present study will help to provide better knowledge of disposition of renal hilar structures which willbe useful for the urological surgeons, radiologists and anatomists.

Application of perihilar surgical techniques in perihilar biliary tract tumours / 中华外科杂志

Perihilar biliary tract tumours include hilar cholangiocarcinoma, gallbladder cancer invading the hepatic hilum and intrahepatic cholangiocarcioma invading the hepatic hilum.The tumours have the special characteristics such as strong invasion capability, the anatomic variant, the pathophysiological complexity, the biological behavior diversity and the difficulty of preoperative evaluation which result in low R0 resection rate, more postoperative complications, more mortality and poor prognosis.The perihilar surgical techniques system aims to set a reasonable and individual operation procedure on the principle of precision surgery by taking the key technique of hilar dissection and exposing, evaluting the hilar anatomy by the means of three-dimensional digital medical image evaluation system, evaluting the relationship between the tumour and hepatic artery and portal vein under the condition of hepatic hilum complete exposure by combining anterograde and retrograde route from intra and extra-hepatic direction to hepatic hilum.The perihilar surgical techniques system is applied to improve the accuracy of resectable evaluation, the R0 radical resection rate, the safety of operation and the accuracy of cholangiojejunostomy through the accurate preoperative evaluation, the detailed operation plan, the accurate intraoperative reassessment, the perfect operative procedure and the excellent postoperative management, eventually for the purpose of reducing the postoperative complications rate and perioperative mortality and improving the prognosis of perihilar biliary tract tumours.

The application of renal sinus anatomy based tension-free reconstruction technique for robot-assisted nephron-sparing surgery of hilar tumors: a single center report and follow-up of 286 cases / 中华泌尿外科杂志

Objective To describe our renal sinus anatomy based tension-free reconstruction technique step by step and report perioperative data and long-term outcomes of patients undergoing robotassisted nephron-sparing surgery for hilar tumors.Methods From June 2013 to December 2016,data of 286 consecutive patients with hilar tumor who underwent RAPN in single center were retrospectively reviewed.There were 202 males and 84 females,aged (56.2 ± 9.2) years.The body mass index was (26.8 ± 3.5) kg/m2.The median diameter of tumor was 2.6 cm(0.8-6.0 cm),and R.E.N.A.L.score was 8.2 ± 1.8.The anatomy-based "Garland" technique specialized in protecting the large hilar vessels and minimizing the tension of trans/retroperitoneal defect suturing approach for anterior/posterior lip hilar tumor respectively.Patient's perioperative complications and long-term follow-up including renal function and oncological outcomes were analyzed.Results "Garland technique" was successfully applied in 284 patients,the warm ischemia time (WIT) was (18.2 ±4.1) min.Median estimated blood loss (EBL) for RAPN was 100 ml (range:10-600 ml).Median operative time was 120 min (range:60-230 min).No patient was converted to open surgery.Postoperative hospital stay was 4.0 d (range:2.0-9.0 d).Three patients (1.1％) had positive surgical margins.Of all the pathological results,260 cases (91.5％)were clear renal cell carcinoma,8 cases (2.8％)were chromophobe renal carcinoma,7 cases (2.5％)were papillary type renal cell carcinoma,5 cases(1.8％) were oncocytoma,3 cases (1.1％)were angiomyolipoma,one case (0.3％) was mucinous tubular and spindle cell carcinoma.Two patients underwent blood transfusion.Three patients(1.0％) had local recurrence.284 patients were alive at a median follow-up of 36 months (range:12-54 months).Conclusions "Garland technique" is safe and feasible for hilar tumor resection and reconstruction with less surgical complications.Large renal vessel injury was avoided and tension of wound closure was minimized.The trans/retroperitoneal approaches are capable for anterior/posterior hilar tumor.Patients with hilar tumor could benefit from robotic surgery with a well preserved renal function and good oncological outcomes.

Hallazgo anatomopatológico en un paciente adulto con una malformación renal congénita o anomalía de fusión / Pathological finding in an adult patient with a congenital renal malformation or fusion anomaly

Se describe el caso clínico de un paciente adulto con antecedentes de alcoholismo e hipertensión, quien falleció fuera de la institución hospitalaria y al realizarle la autopsia se encontró una ectopia renal cruzada con fusión, así como un único sistema excretor.

The case report of an adult patient with a history of alcoholism and hypertension who died outside of the hospital institution is described, and when carrying out the autopsy a cross renal ectopia with coalition, as well as only one excretory system were found.

Extra Hilar Branching of Renal Arteries: An Anatomical Study.

Introduction: The objective of this study was to observe the patterns of different arteries that supply the kidneys. The kidney has a segmental distribution of arteries. The kidneys are divided into five vascular segments. The arteries that arise from the aorta above or below the main renal artery and reach the hilum are called accessory renal arteries. They are persistent embryonic lateral splanchnic arteries. Accessory renal arteries may arise from the celiac or superior mesenteric arteries, near the bifurcation or from the common iliac arteries. The present study has attempted to find out accessory, and aberrant arteries to kidneys with review of literature. Materials and Methods: The study was done on 52 kidneys randomly selected from cadavers that were used for the purpose of teaching in the department of Anatomy at P.E.S Medical College. The kidneys were removed from the cadavers en-block with the arteries and veins intact. The renal artery was observed for its pattern of branching. Observations and Discussion: The pre-hilar branching pattern was absent only in six kidneys out of the 52 kidneys selected. The branches given before entering the hilum were either in the form of a fork pattern or a ladder pattern in the remaining 46 kidneys. The fork pattern wherein the branches arose from a single point was found in 42 kidneys. The ladder patterns were seen in two posterior segment arteries and two anterior segment arteries. The anterior division often showed the fork patterns which were either duplicate or triplicate outside the hilum more proximally, with further division into duplicate or triplicate terminal branches closer to the hilum but significantly outside.

Anatomical Study Of Arrangement Of Renal Hilar Structures In Indian Adult Human Cadavers.

Abstracts: Background: Knowledge of arrangement of renal hilar structure is essential in the era of minimally invasive surgery. Nephron sparing surgeries like partial nephrectomy by laparoscope is treatment of choice and in this surgery hilar dissection is one of the important steps. However, in literature very few reports are available regarding the different patterns of dispositions of renal hilar structures. Aim of present study was to evaluate the arrangement of renal hilar structures. Methodology: Present work was carried out on fifty seven pairs of morphological normal kidneys of embalmed cadavers. Renal hilum of each kidney was dissected carefully to see the arrangement of renal artery, vein and pelvis. Results: Arrangement of renal hilar structures showed great variation. We classified arrangement of renal hilar structures into ten different patterns. In 22.80 % kidney we observed the arrangement of hilar structures according to textbooks. We observed anterior and posterior tributaries of renal vein in 32.45% and in 41.22% kidneys pelvis was the posterior most relation. Conclusion: Present study will help to understand the better knowledge of the disposition of hilar structures for the urological surgeons, radiologist and anatomists.