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Lower Midline Incision

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 case of unexpected intraoperative situations, a lower midline incision can be easily extended.

Preoperative Patient Preparation

• Patient positioning: supine position with slight hyperextension of the lumbar spine
• General anesthesia
• Perioperative antibiotic prophylaxis, if the urinary or gastrointestinal tract is entered or if risk factors for surgical site infections are present.

Surgical Technique of a Lower Midline Incision

• Skin incision see fig. lower midline incision
• Cut through the subcutaneous fat tissue and expose the rectus sheat
• Division of the linea alba and fascia transversalis. Blunt dissection of the Retzius' space.
• Using blunt dissection, the peritoneum is pushed superiorly and medially to expose the iliac vessels, spermatic cord and ureter.

Lower midline incision

References