Paramedian extraperitoneal incision for total nephroureterectomy

Tessler, Arthur N.; Yuvienco, Francisco; Farcon, Eduardo

doi:10.1016/0090-4295(75)90166-1

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…Traditional access to the retroperitoneum is through a midline transperitoneal (TP) approach or via extraperitoneal flank incision 1,2 . Midline TP access allows usual supine positioning to reduce cardiovascular‐pulmonary complications but at a cost of increased intra‐abdominal organ injury, adhesions and ileus 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Traditional access to the retroperitoneum is through a midline transperitoneal (TP) approach or via extraperitoneal flank incision. 1,2 Midline TP access allows usual supine positioning to reduce cardiovascular-pulmonary complications but at a cost of increased intra-abdominal organ injury, adhesions and ileus. 3 Extraperitoneal flank incision overcomes the risks associated with entering the abdominal cavity however conveys a higher incidence of pneumothorax, injury to the subcostal nerves and flank muscles.…”

Section: Discussionmentioning

confidence: 99%

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Midline extraperitoneal approach to retroperitoneal pathology ‐ broadening the horizons

Kovacic

Hanna²,

McCombie

et al. 2022

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Midline extraperitoneal approach to retroperitoneal pathology ‐ broadening the horizons

Kovacic

Hanna²,

McCombie

et al. 2022

ANZ Journal of Surgery

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“…Tracing back to our history of evolution, unilateral hand-assisted retroperitoneoscopic nephroureterectomy (HARN) was performed via a Gibson incision at our institution. Based on accumulated experiences and skills, unilateral extraperitoneal nephroureterectomy could be practiced through a paramedian incision [ 13 ]. During this period, a camera port was required to insert a laparoscope and ensure the security of en bloc ligation of renal vessels; an extended paramedian incision could immediately be made as if major bleeding needed to be treated.…”

Section: Discussionmentioning

confidence: 99%

A Modified Single Mini-Incision Complete Urinary Tract Exenteration for Urothelial Carcinoma in Dialysis Patients

Chen

Lin

Tsai

et al. 2014

BioMed Research International

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Objective. To present our experience with single mini-incision complete urinary tract exenteration (CUTE) for female dialysis patients suffering from urothelial carcinoma (UC). Patients and Methods. Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally. Results. All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography. Conclusions. This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.

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“…Although a midline extraperitoneal approach has been utilized for retroperitoneal lymph node dissection or sympathectomy, to our knowledge nephrectomy using this approach has not been previously described in the literature. In 1966 and 1969, Ulm reported a paramedian rectus‐retracting extraperitoneal approach for renal surgery, 2,3 and Tessler has adopted it for nephroureterectomy in 1975 4 . However, this approach has not become widely accepted, probably because of limited skin incision and limited exposure due to the costal margin.…”

Section: Introductionmentioning

confidence: 99%

Midline extraperitoneal approach to upper urinary tract surgery: Anatomical basis of surgical technique

et al. 2006

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To overcome the disadvantages inherent in the standard surgical approach to the kidney, we introduced a novel surgical technique via a midline extraperitoneal approach. The surgical technique is not substantially different from that of the standard midline transperitoneal approach, except no entry is made into the peritoneal cavity. Although the peritoneum itself is extremely thin and fragile, the peritoneum together with underlying subperitoneal fascia can be dissected readily as a substantial layer, if the proper plane is dissected. Further medial mobilization of the peritoneal sac en bloc by pursuing the fusion fascia plane allows full exposure of the kidney, ureter and great vessels. This approach was adopted for consecutive 51 patients during a 10-month period in 2003. All operations, including 33 radical nephrectomies and 11 nephroureterectomies were completed successfully without significant technical difficulties and differences in operation time and estimated blood loss compared to the transperitoneal approach. No intra-or perioperative complication occurred. All patients did seem to have a much more comfortable postoperative period with minor pain and few abdominal complaint, and the clinical impression was that they resumed the physical activity and oral intake earlier than those after the transperitoneal approach (P = 0.056). There are no operation-related problems such as intra-abdominal adhesion or abdominal muscle weakness resulting in some deformity at 2-year or more follow up. This approach combines the advantages of the transperitoneal midline and extraperitoneal flank approach. Its use will undoubtedly reduce the complications inherent in the transperitoneal approach or the flank approach.

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Paramedian extraperitoneal incision for total nephroureterectomy

Cited by 6 publications

References 2 publications

Midline extraperitoneal approach to retroperitoneal pathology ‐ broadening the horizons

Midline extraperitoneal approach to retroperitoneal pathology ‐ broadening the horizons

A Modified Single Mini-Incision Complete Urinary Tract Exenteration for Urothelial Carcinoma in Dialysis Patients

Midline extraperitoneal approach to upper urinary tract surgery: Anatomical basis of surgical technique

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