RADICAL NEPHRECTOMY

INDICATION:
Renal cell carcinoma

SURGICAL TECHNIQUE:

The incision extends from the angle of the 12th rib posteriorly
to 8-15cms beyond the tip of the 12th rib anteriorly
The three muscle layers (external and internal oblique and transverses muscles) are divided, carefully avoiding the intercostals and

sub-costal nerves.
Then the ureter is exposed and snared, the perirenal fat displaced and the posterior aspect of the kidney exposed.
The peritoneum, which adheres to the kidney is separated and the kidney mobilized the peritoneum is closed with vicryl sutures.]
Dissection of the upper pole of kidney from fatty tissue and supra renal gland is achieved by blunt dissection. One should also look for

accessory vessels and ligate them or coagulate them is required.
Delivery of the lower pole is also achieved in the same way.
After both the poles of the kidney have been mobilized and renal artery, renal vein and the ureter are dissected.
Care should to avoid injury to the ovary or testicular vein on the left side and the suprarenal veins on both sides.


The renal artery is snared and the kidney turned medially to expose the renal vein, which is located behind and above the artery.
After double ligation with vicryl division of the renal artery is done.
The renal vein is treated in the same way.
The kidney is removed after division of the perinephric fat overlying Gerota’s fascia the lymph nodes around the area.
A 20Fr silastic tube drain is placed with its tip within the gerota’s fascia, it is brought out through the gerota’s fascia, through a

separate stab incision.
The wound is closed in layers



SUB CAPSULAR:

SURGICAL TECHNIQUE:

The incision extends from the angle of the 12th rib posteriorly
to 8-15cms beyond the tip of the 12th rib anteriorly
The three muscle layers (external and internal oblique and transverses muscles) are divided, carefully avoiding the intercostals and

sub-costal nerves.
The gerota’s fascia is then incised with scissors, followed by blunt dissection.
The ureter is exposed and snared, the perirenal fat displaced and the posterior aspect of the kidney exposed.
The peritoneum adherent, the sabcapsular area is opened. . Dissection of the

upper pole of kidney from fatty tissue and supra renal gland is achieved by blunt dissection. One should also look for accessory vessels and ligate them or

coagulate them is required
Delivery of the lower pole is also achieved in the same way.
After both the poles of the kidney have been mobilized and renal artery, renal vein and the ureter are dissected.
Care should to avoid injury to the ovary or testicular vein on the left side and the suprarenal veins on both sides.


The renal vein is snared and the kidney turned medially to expose the renal artery, which is located behind and above the vein.
After double ligation with vicryl division of the renal artery is done.
The renal vein is treated in the same way.
The kidney is removed after division of the ureter between clamps.
A 20Fr silastic tube drain is placed with its tip within the gerota’s fascia, it is brought out through the gerota’s fascia, through a

separate stab incision.
The wound is closed in layers.