Extrarenal Visceral Arteries Injuries during Left Radical Nephrectomy: A 50-Year Continuing Problem

Area of Science:

• Surgical Anatomy
• Vascular Surgery
• Nephrology

Background:

• Left radical nephrectomy, regardless of surgical approach (open, laparoscopic, robotic), carries a risk of injury to adjacent major abdominal vessels.
• The superior mesenteric artery (SMA) and celiac trunk (CT) are particularly vulnerable due to their anatomical relationship with the left renal hilum.
• These vascular injuries, though infrequent, can lead to significant morbidity and mortality.

Purpose of the Study:

• To provide a comprehensive 50-year narrative review of injuries to the SMA and CT during left radical nephrectomy.
• To elucidate the anatomical and pathophysiological underpinnings of these injuries.
• To outline current strategies for prevention, diagnosis, and treatment.

Main Methods:

• A 50-year narrative review of the medical literature.
• Analysis of anatomical variations and surgical techniques related to left radical nephrectomy.
• Synthesis of data on risk factors, clinical presentations, and management outcomes.

Main Results:

• Detailed anatomical considerations highlight the proximity of the SMA and CT to the left renal hilum.
• Risk factors associated with open, laparoscopic, and robotic approaches are identified.
• Diagnostic criteria and therapeutic interventions, including surgical repair and endovascular options, are discussed.

Conclusions:

• Awareness of anatomical variations and meticulous surgical technique are crucial for preventing SMA and CT injuries during left nephrectomy.
• Prompt diagnosis and appropriate management are essential to minimize complications.
• This review consolidates existing knowledge to guide surgeons in managing these challenging vascular injuries.