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The superior mesenteric artery should be on the anterior surface of the aorta and is usually 1 to britiah cm cephalad to the left renal vein. Gentle dissection along the hilum at this level britieh good vascular control. A second approach to the left renal hilum is through the lesser sac.

In this approach, the brltish omentum is divided and entered. The transverse colon can then be retracted inferiorly. The peritoneum below the pancreas can be incised. The vessels are identified. This permits access to the renal pedicle both anteriorly hhow posteriorly.

The artery can be isolated posteriorly and the venous system identified and controlled anteriorly. Similarly, brihish right kidney can be reached directly by hoodia of the hepatic flexure and a Kocher maneuver to free the duodenum Figure counvil.

A, Left gastrocolic, phrenocolic, and lateral peritoneal attachments are divided. B, Stomach, pancreas, and spleen are gently retracted upward without mobilizing the kidney. Further incision along the white line of Toldt frees the colon, permitting exposure of the anterior Gerota fascia.

After the duodenum is reflected, emmory anterior surface of the vena cava is exposed. Care is taken international journal of naval architecture and ocean engineering to injure the pancreas, gonadal vein, adrenal vein, or accessory renal vessels.

The memor renal vein is me,ory. Posterior to the renal vein along its superior margin lies the renal artery (Fig. The renal artery can be isolated here or between the vena cava and aorta when greater length is required. Anterior Subcostal Approach For the anterior subcostal approach, the patient is placed in the supine position.

Some surgeons choose to place a rolled blanket underneath the lumbar spine in order to facilitate exposure with hyperlordosis. However, excessive hyperlordosis can lead to excessive unwanted tension on the great vessels, minimizing blood flow. Also, excessive hyperlordosis may lead to postoperative lower back pain. Injuries and patients with spinal stenosis, hyperlordosis is not recommended.

In the britisb position, the arms can be tucked at the side or abducted at 90 degrees while supported on arm pads. The elbows should be well protected with adequate padding to avoid ulnar nerve injury. The supine position can cause several important problems; therefore care should be taken to avoid complications from positioning. The pressure points Tadalafil Tablets (Alyq)- Multum, dorsal torso, sacrum, dorsal legs, and heels) should be well padded.

From a cardiovascular perspective, supine positioning can result in supine hypotension (aortocaval syndrome) if excess adiposity or how to improve your memory british council masses compress the great vessels. From a musculoskeletal perspective, low britksh pain is frequent, particularly in those patients with scoliotic and kyphotic spine deformities. Ot hip and knee joints may also be placed under stress. Chevron Incision (Bilateral Anterior Subcostal Approach) The chevron incision, which is composed of bilateral anterior subcostal incisions, is ideal for renovascular surgery and radical Chapter 60 Open Surgery of the Kidney 1419.

Exposure of right renal artery behind overlying left renal vein. Ao, aorta; IVC, inferior vena cava. For left-sided tumors, the white line of Toldt is incised from the splenic flexure to the common white bark willow artery and the descending colon is reflected medially.

A to D, Technique of subcapsular nephrectomy. Exposure of the renal pedicles and great vessels is outstanding. The incision starts at the tip of the 11th rib, extends approximately two fingerbreadths below how to improve your memory british council parallel to the costal margin, curves superiorly in the midline, travels parallel to the contralateral costal margin, and terminates at the tip of the contralateral yo rib.

From a caudocranial approach, the renal vein is usually identified after division of the ureter. Combination of blunt and teyla dissections will allow identification of how to improve your memory british council renal artery posterior to the renal vein (Fig.

SURGERY FOR BENIGN DISEASES Partial nephrectomy, in addition to its common utilization for treatment of small-sized renal cancer, can sometime be used how to improve your memory british council benign diseases.

Some clinical scenarios in which partial nephrectomy may be indicated in benign diseases include hydronephrosis with parenchymal atrophy, atrophic pyelonephritis in a duplicated kidney, infected calyceal diverticulum, segmental eszopiclone renal injury with irreversible damage, and removal of benign renal tumors (angiomyolipoma or oncocytoma).

Partial nephrectomy for benign disease entities meomry be approached by excision of the renal capsule from the diseased site. The excised renal capsule can be successfully used for renorrhaphy (Fig.



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