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Role of three‐dimensional imaging in surgical planning for kidney surgery

Three-phase helical CT is recommended for 3D imaging for surgical planning [12–15] (Fig. 1). When examining the urinary tract, an unenhanced scan is taken to locate the kidneys and assess calcifications, and to provide a baseline with which to characterize renal lesions after the intravenous administration of contrast medium. Next, non-ionic contrast medium is injected at 3–4 mL/s through an 18 G intravenous catheter, and a corticomedullary or vascular phase scan taken to identify renal vasculature, including early and segmental renal artery branches and late vein confluences [16]; this scan phase can also contribute to characterizing the lesion. The delay time is determined either by timing the bolus, or via an automated system, and begins 30–40 s after the start of infusing the contrast medium. For lesion detection and characterization, the nephrographic phase scan remains the most sensitive phase [17–19]. The nephrographic phase begins 120–150 s after the start of infusing the contrast medium. The test bolus or a 20-mL contrast medium pre-load can be used to opacify the collecting system to determine if a tumour involves the calyces.