Surgical anatomy of the kidney with special interest in complex renal vasculature and its implications in surgical procedures

A detailed understanding of both the normal and variant surgical anatomy of the kidney is vital for preoperative planning and management of patients with kidney disease. This study reviews the literature regarding the surgical aspects and outcomes of working with kidneys that have anatomical variations. Particular interest was paid to complex renal vasculature in living donor transplant. This study broadly classified the anatomical variations of the kidney into gross, arterial, and venous anomalies. These variations, particularly those involving the arterial supply, need to be taken into consideration during surgical procedures, including renal transplant, as they can cause challenges for both retrieval and implantation. Pre-operative imaging and angiography is of high importance in order to identify any vascular anomalies. This study recommends that surgeons should have complex knowledge of where aberrant vessels may be located in order to reduce the risk of vascular damage, which can lead to overall reduced patient and graft survival rates. It was found that multi-vessel kidneys should not be refused as donations as the renal transplants using multi-vessel kidneys have no significant difference in terms of graft and patient survival rates, as well as post-operative complication rates.