ABSTRACT
Renal trauma may result in serious intra-abdominal or retroperitoneal haemorrhage, but rarely results in uroperitoneum; lower urinary tract damage is the more usual cause of this.
319-337 Nephrectomy technique. (319) The kidneys can be approached from flank or ventral abdominal incisions. The author prefers a ventral midline abdominal approach, extending from the xiphisternum to just caudal to the umbilicus (for nephrectomy alone) or to the pubis (for ureteronephrectomy). The advantage of the midline approach over a flank approach is that it allows access to a greater area of the abdomen. This is important in cases of renal neoplasia (to examine for the presence or absence of metastases) and/or if the ureter is also diseased and requires removal. In addition, most surgeons are more familiar with this approach than the use of flank incisions. Once the abdomen is opened, the kidneys must be located. (320) The right kidney is found by locating and elevating the duodenum, as illustrated. (321) If the duodenum is now reflected medially, the right kidney is exposed and the mesoduodenum is used to prevent the intestines from returning to the right side of the cranial abdomen. (322) The left kidney is located similarly, except that the descending colon is found and elevated.
