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1 flank Supracostal Useful for radical nephrectomy for modest-sized tumor and partial nephrectomy Extraperitoneal, extrapleural approach Good renal, suprarenal,

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Presentation on theme: "1 flank Supracostal Useful for radical nephrectomy for modest-sized tumor and partial nephrectomy Extraperitoneal, extrapleural approach Good renal, suprarenal,"— Presentation transcript:

1 1 flank Supracostal Useful for radical nephrectomy for modest-sized tumor and partial nephrectomy Extraperitoneal, extrapleural approach Good renal, suprarenal, and retroperitoneal exposure Permits pivoting of the 11th or 12th rib on a single articulating surface posteriorly without removal of a rib, Abdominal panniculus falls away from incision Poor option for patients with significant scoliosis or who will not tolerate flank position (e.g., severe pulmonary comorbidity) Longer operative time Risks chronic flank pain and bulge and ischemic injury to a postoperative contralateral kidney Flank Transcostal Same as supracostal Same as supracostal Morbidity due to rib resection

2 2 Thoracoabdominal Useful for radical nephrectomy and partial nephrectomy of large renal masses, especially those of the upper pole Valuable for right-sided tumors in which the liver and hepatic veins would reduce exposure and make vascular control difficult using a different approach Useful for radical nephrectomy for renal tumors with venous extension and those involving adjacent structures (e.g., liver, spleen, or pancreas) as well as for excision of suprarenal masses Provides maximal suprarenal exposure Permits synchronous biopsy or resection of pulmonary lesions Longer operative time Greater potential pulmonary morbidity Damage to phrenic nerve

3 3 Anterior Subcostal (extraperitoneal or transperitoneal) Useful for open renal biopsy, nephrectomy and renovascular surgery Favorable approach for upper pole tumors and in patients with a wide subcostal angle, Provides good access to the superior and lateral aspect of kidney; the transperitoneal approach permits good access to the renal hilum The extraperitoneal approach diminishes risk of ileus and intra-abdominal injury The extraperitoneal approach provides limited access, especially to the pedicle The transperitoneal approach may risk ileus, adhesions and bowel obstruction The left transperitoneal anterior subcostal approach has been associated with splenic injury

4 4 Anterior Chevron Useful for renovascular surgery and renal tumors extending into the vena cava Useful in obese patients and in those with a wide subcostal angle Provides outstanding access to both kidneys, renal pedicles, and the great vessel Ileus, adhesions, and possible bowel obstruction Transection of the abdominal wall muscles may lead to pain and morbidity

5 5 Midline anterior transperitoneal Useful for trauma, renovascular surgery, reconstructive procedures (e.g., ileal ureter), and bilateral procedures Rapid Provides good access to renal pedicle Practical in patients with a narrow subcostal angle Ileus, adhesions, and possible bowel obstruction Anterir Paramedian (extraperitoneal or transperitoneal) Same as midline Provides added strength with two-layer fascial closure Ileus, adhesions, and possible bowel obstruction (transperitoneal) Limited exposure of the kidney (extraperitoneal)

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