Dr. med. Dirk Manski

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Lower Midline Incision: Surgical Steps and Wound Closure

Urologic Indications

In urology, a lower midline incision is used for an extraperitoneal approach to the prostate, bladder, distal ureters, and pelvic lymph nodes. In unexpected intraoperative findings, a lower midline incision can be easily extended.

Patient Positioning:

The patient is in a supine position with slight hyperextension of the lumbar spine.

fig. lower midline incision
Lower midline incision.

Surgical Technique of a Lower Midline Incision

Wound Closure of Midline Incision

Wound closure is best done with the short stitch technique; continuous running suture (monofilament, elastic, slowly absorbable, suture size USP 0 or 2-0), tissue bites of 5 mm and intersuture spacing of 4–5 mm are applied exclusively to the fascia (linea alba) (Deerenberg et al., 2015). See also the section wound closure of transperitoneal midline laparotomy.

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


E. B. Deerenberg et al., “Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial.,” Lancet, vol. 386, no. 10000, pp. 1254–1260, 2015, doi: 10.1016/S0140-6736(15)60459-7.

J. A. Smith, S. S. Howards, G. M. Preminger, and R. R. Dmochowski, Hinman’s Atlas of Urologic Surgery Revised Reprint. Elsevier, 2019.

  Deutsche Version: Mediane Laparotomie