Anatomical reconsideration to renal area: Lessons learned from radical nephrectomy or adrenalectomy through a minimal incision over the 12th rib

Abstract

Background : To perform radical nephrectomy or adrenalectomy through a minimal incision over the 12th rib and to compare this with the traditional supracostal or transcostal approach. We review and clarify the related surgical anatomy through close observation. Methods : We performed radical nephrectomy in six patients with upper urinary tract carcinoma through a minimal incision over the 12th rib and in five patients with renal cell carcinoma through a medium-sized incision, and adrenalectomy in five patients (bilaterally in one) again through a minimal incision over the 12th rib. During surgery, special points were noted to find out the differences between the new minimal-incision approach and the conventional approach.Results : The procedures were accomplished smoothly with no complications through either a minimal or medium-sized incision. From our observation, it is clear that most of the procedures involved in the minimal-incision approach were and should be carried out within the space created in the retroperitoneum beneath the lateroconal fascia. Conclusion : Entering the correct anatomical planes posteriorly and anteriorly in the renal fasciae is a prerequisite for full mobilization of the kidney, together with the perinephric fat. To perform this, recognition of the lateroconal fascia and incising it along the correct lines are of the utmost importance for minimal-incision radical nephrectomy and adrenalectomy. Furthermore, this anatomical approach is also important for the conventional open approach and laparoscopic approach.

Experience in the application of laparoscopic anatomical adrenalectomy via the renal cortex surface monolayer

“…Surgeons can, according to preoperative imaging, calculate and measure the distance from the skin to Gerota's fascia, the upper boundary of the adrenal gland and kidney, the distance from the adrenal gland to the 12 th rib, the distance from the 12 th rib to the ilium, and the fat thickness and consequently decide on an operation method. [3][4][5] treated 56 patients with HAL to assess the curative effect of this method on adrenal tumors larger than 5 cm. He noted that HAL was a safe and repeatable adrenal gland surgery method and an effective combination of a minimally invasive surgery with tactile sense.…”

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

“…This suggests that correct anatomical recognition of the posterior RF and the LCF during operation is sometimes difficult. In addition, the pararenal space contains connective tissue fibers similar to the perirenal space 129) . Therefore, clear anatomic assessment and identification of the pathway for exposure to the PPS in preoperative images is beneficial, and gentle and meticulous surgical detachment of the posterior RF, LCF, or the peritoneum from the TF and the psoas fascia is essential for safe and reliable lateral approach surgery.…”

“…This suggests that difficulty in discrimination result in misinterpretation of the laminar configurations during surgery. Laparoscopic urologic surgeons have emphasized a correct understanding of the LCF in the lateral aspect of the kidney 129,130) . However, the LCF remains unknown to many surgeons, especially spine surgeons, unfamiliar with older orthopedic or spinal surgery textbooks.…”

Bone single-photon emission computed tomography and three-dimensional computed tomography in the diagnosis of low costal variation and pathologies

“…The posterior approach requires an incision at the level of the spinous process of the first lumbar vertebra to avoid entering the pleura. [ 4 5 6 ] On the thoracolumbar computed tomography (CT), there was only five lumbar vertebra and right 12 th rib aplasia and left 12 th rib hypoplasia [ Figure 1b ]. But there was no pathological finding to explain the pain.…”