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Flank Incision: Surgical Approach to the Kidney

Flank incision: the patient is placed in lateral position on a flexed operation table.

Urologic Indications for a Flank Incision

Kidney Surgery

• Simple nephrectomy or radical nephrectomy
• Partial nephrectomy
• Open nephrolithotomy

Surgery of the Ureter

• Nephroureterectomy
• Open pyeloplasty
• Ureteroureterostomy

Preoperative Patient Preparation for a Flank Incision

• Insertion of a transurethral catheter
• Epidural anesthesia
• General anesthesia
• Patient positioning: the patient is placed in lateral position on a flexed operation table, see fig. flank incision.
• Perioperative antibiotic prophylaxis, if the urinary or gastrointestinal tract is entered or if risk factors for a wound infection are present.

Flank Incision: Surgical Technique

• Skin incision above and in direction of the 11th intercostal space.
• Dissect the external oblique muscle in direction of the muscle fibers just above the 12th rib.
• Transection of the internal oblique muscle perpendicular to the muscle fibers with electrocauterization. The transversus abdominis muscle is cut in a muscle splitting technique.
• Injury to the subcostal nerve must be avoided, access below the 12th rib is not advisable.
• Transection of the intercostal muscles is done with care not injuring the pleura. Insert a retractor between the ribs (without breaking them).
• Open the renal fascia and bluntly dissect the layer between perirenal fat and the psoas muscle. Dissect the peritoneum of the perirenal fat to expose the kidney from all sides.

References

  Deutsche Version: Flankenschnitt