Mini-flank supra-11th rib incision for open partial or radical nephrectomy Journal Article

Authors: DiBlasio, C. J.; Snyder, M. E.; Russo, P.
Article Title: Mini-flank supra-11th rib incision for open partial or radical nephrectomy
Abstract: OBJECTIVE: To report our approach to partial (PN) or radical nephrectomy (RN) using a supra-11th mini-flank incision, as the widespread availability of advanced imaging has increased the detection of incidental, lower-stage renal tumours that are generally amenable to resection using smaller incisions. PATIENTS AND METHODS: The study included 167 consecutive patients undergoing PN/RN for renal tumours treated between February 2000 and March 2003 using the supra-11th rib mini-flank approach. Variables analysed were age, gender, nephrectomy type (PN vs RN), operative duration, estimated blood loss (EBL), hospital stay, tumour size and location, pathological stage and histology, perioperative transfusions, and complications. Patients undergoing PN were examined for ischaemia type (cold, warm, none) and duration of renal artery clamping. The interval after surgery to initiate solid diet and discontinue patient-controlled analgesia, and overall pain control, were analysed and compared between PN and RN. RESULTS: In all, 133 patients (80%) underwent PN and 34 (20%) RN, at a median age of 61.7 years. The median operative duration was 2.9 h, the EBL 400 mL, tumour size 3.2 cm and median hospital stay 5 days. At a median follow-up of 18.2 months, there were seven (4%) late complications: six patients had a flank bulge and one had a reducible hernia. Surgical margins were negative in 164 (98%) patients. CONCLUSIONS: The supra-11th rib mini-flank incision offers a practical alternative to traditional open or laparoscopic PN or RN. Using a small (8 cm) incision with no rib resection, this approach affords optimum exposure without compromising cancer control, with excellent cosmetic results and a lower risk of late complications at the wound site. © 2006 BJU International.
Keywords: adult; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; surgical technique; retrospective studies; major clinical study; histopathology; postoperative period; cancer staging; follow up; methodology; neoplasm staging; prospective study; prospective studies; diagnostic procedure; tumor localization; pain; tumor volume; pathology; surgical approach; retrospective study; kidney neoplasms; nephrectomy; postoperative complication; postoperative complications; length of stay; hospitalization; diet; kidney; kidney tumor; ischemia; operation duration; hernia; imaging; perioperative period; age distribution; gender; postoperative hemorrhage; surgical anatomy; tumor diagnosis; analgesic agent; surgical procedures; artery clamp; renal artery; transfusion; incision; rib; operative therapy
Journal Title: BJU International
Volume: 97
Issue: 1
ISSN: 1464-4096
Publisher: Wiley Blackwell  
Date Published: 2006-01-01
Start Page: 149
End Page: 156
Language: English
DOI: 10.1111/j.1464-410X.2006.05882.x
PUBMED: 16336347
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 20" - "Export Date: 4 June 2012" - "CODEN: BJINF" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Paul Russo
    548 Russo
  2. Mark Snyder
    26 Snyder