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Flank Incision: Surgical Approach to the Kidney
Urologic Indications for a Flank Incision
Surgery of the Ureter
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.
|thoraco-abdominal incision||Index||lower midline incision|
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Deutsche Version: Flankenschnitt