Morphological variability of renal hilar structures in humans: Insights from cadaveric observation

The renal hilum serves as the entry and exit point of the kidney, transmitting the renal vein, renal artery, and renal pelvis. The classical anatomical arrangement from anterior to posterior is the renal vein, renal artery, and renal pelvis. However, variations in this configuration are common and carry significant clinical implications for surgical and radiological procedures. To examine and categorize variations in the arrangement of renal hilar structures through cadaveric dissection and to assess their clinical significance. A total of 112 kidneys (54 left and 58 right) obtained from cadaveric dissections were studied. The arrangement of the renal vein, renal artery, and renal pelvis at the hilum was carefully observed and documented. Variations from the classical pattern were noted, categorised, and analysed for frequency and laterality. Out of 112 kidneys examined, only 18 (16%) exhibited the classical anterior-to-posterior arrangement of renal vein, renal artery, and renal pelvis. The remaining 94 kidneys (84%) displayed eight distinct variation patterns. Variations were more frequent in the left kidneys, possibly reflecting their more complex embryological development. The most common deviations involved the prehilar branching of the renal artery and the presence of additional venous tributaries, which altered the usual hilar configuration. Renal hilar variations are highly prevalent and must be carefully considered during surgical and radiological procedures. Awareness of these anatomical variations is crucial for preventing intraoperative complications such as haemorrhage or ischemia and for ensuring accurate interpretation of renal imaging. The paper highlights the importance of a detailed preoperative assessment and supports the need for a standardized classification of renal hilar anatomy. • Dissection of 112 cadaveric kidneys was done to document hilar structure variations. • Variations observed in 84% of kidneys; 16% showed classical hilar arrangement. • Eight distinct variant hilar configurations were identified, showing embryological diversity. • Left-sided variations were more frequent than right-sided patterns. • Preoperative renal vascular mapping is essential for laparoscopic and robotic surgery.