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Published on: April 29, 2014
CT appearances following laparoscopic partial nephrectomy for renal cell carcinoma using a rolled cellulose bolster
Deepa Pai1, Jonathon M Willatt, Melvyn Korobkin
1Departments of Radiology, University of Michigan Hospitals, Ann Arbor, MI 48109, USA.
Purpose:
To describe the evolving computed tomography (CT) appearances of a cellulose surgical bolster used as a hemostatic agent in patients who undergo laparoscopic partial nephrectomy for renal cell carcinoma.
Materials And Methods:
We retrospectively reviewed the follow-up CT studies of 33 patients with stage T1N0M0 renal carcinoma who underwent laparoscopic partial nephrectomy using a rolled, oxidized, regenerated cellulose sheet sutured in place as a bolster in the parenchymal defect. Thirteen patients undergoing laparoscopic partial nephrectomy without the use of a bolster were also evaluated to differentiate imaging features.
Results:
The bolster-related masses were significantly larger than those seen in the non-bolster patients. There was a decrease in size of the post-operative bolster-related mass with time. The bolster shape evolved with time, initially appearing oval, and becoming irregular with decreasing size. Equivocal increase in attenuation of 10-20 HU was seen in 6 patients. Increase in attenuation of greater than 20 HU was seen in 3 patients. There was no evidence of tumor recurrence in any of the patients. Invagination of fat was seen in two bolster-related masses at 18 months or greater.
Conclusions:
Cellulose bolster has a variable appearance on follow-up CT exams. Evolutionary features include reduction in bolster size and shape with time leading finally to non-visualization. Bolster enhancement can mimic abscesses and tumor recurrence.
