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Urologic Indications for a Midline Laparotomy
- Retroperitoneal lymphadenectomy
- Nephrectomy for large renal tumors
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 Median Laparotomy
- Midline skin incision [fig. midline laparotomy]. The length of the laparotomy depends on the operation: full length is needed for retroperitoneal lymphadenectomy or nephroureterectomy. A lower midline incision just above the umbilicus is done for cystectomy. For nephrectomy, a laparotomy incision from xiphoid to just below the umbilicus is often sufficient.
- After exposure of the ventral lamina of the rectus sheat, the linea alba is dissected above the umbilicus. Grasp the peritoneum with forceps, elevate and dissect, that two fingers can palpate the abdominal cavity. If adhesions can be ruled out, die laparotomy is quickly extended as needed with a scalpel or scissor, on hand protects the bowel.
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Deutsche Version: Mediane Laparotomie