Dr. med. Dirk Manski

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Subcostal and Chevron Incision: Surgical Technique

Urologic Indications for a Subcostal Incision

The subcostal or Chevron incision is used for a transperitoneal approach to the kidney or adrenal gland for larger tumors; see radical nephrectomy or adrenalectomy. A subcostal incision is an option if a flank position for a simple nephrectomy is not possible.

fig. subcostal of Chevron incision
Subcostal of Chevron incision

Patient positioning:

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

Surgical Technique (Step by Step) of a Subcostal Laparotomy

Wound closure:

The first layer (peritoneum, posterior lamina of the rectus sheath, transverse abdominal muscle) is closed with a continuous running suture (monofilament, elastic, slowly absorbable, suture size USP 0 or 1). The second layer (anterior lamina of the rectus sheath, external and internal oblique abdominal muscle) is closed with a running suture or in an interrupted fashion.

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


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

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