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Subcostal or Chevron Incision
Urologic Indications for a Subcostal Incision
- Radical nephrectomy
- Simple nephrectomy, if contraindications for a flank incision are present.
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 a wound infection are present.
Surgical Technique of a Subcostal Incision
- The skin incision is shown in fig. subcostal incision. The incision can be extended to the opposite side along the dotted line (Chevron incision).
- Exposure and incision of the ventral lamina of the rectus sheat. Incision of the external oblique muscle of the abdomen in direction of the muscle fibers. The rectus muscle is cut with electrocautery. Grasp the posterior lamina of the rectus sheath near the midline between forceps and open the peritoneum. If adhesions can be ruled out, the laparotomy is quickly extended as needed with electrocautery, one hand protects the bowel. Transection of the ligamentum teres hepatis between ligatures to mobilize the liver.
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