Lumbotomy 4l195e

LUMBOTOMY

DEFINITION  Also

known Flank subcostal incision (below twelfth ribs incision) is surgical approach consists of a lumbar incision to provide direct extraperitoneal acces to the kidney and mid and upper ureter without entering the peritoneal cavity. (Manual of Urologic Surgery, 2012)

Nephrolithoto my Benign Renal Lesions

Nephrectomy,

Drainage of abscess, etc INDICATION Proximal ureterolithoto my Surgery of upper urologic tract

Pyelolithotom y Pyeloplasty, etc

ANATOMY

EQUIPMENT Sterile gawn, gloves, cap and mask

Sterile drap

Sterile gauze

Povidone iodine

Disinfection clamp / ring clamp

Towel clamp

Surgical blade and scalpel handle

Electric cauter device

Sharp spreader

Langenback

Kocher clamp

Suction device

Mosquito clamp

Scissors

Metzenbaum

Neddle holder

Rectangle

Forceps

Millin’s retractor

Drain

Foley catheter and urobag

Plain catgut

Polyglicolic acid

Polypropylene

SURGICAL TECHNIQUE  After

general anaesthesia, place the patient in the full flank position with the table flexed. (Hinman Atlas of Urologic Surgery, 2012)

Disinfect the operation field using 10% of povidone iodine (starting at the operation field, front : untill the umbilicus, rear : untill the spine, cranial : papillary line, caudal : iliac crest). Narrow the operation field using sterile drapping.

Umbilicus

Rib XII

The incision is made just above the rib from the posterior axillary line across to the lateral border of the rectus abdominis towards the umbilicus. (Hinman Atlas of Urologic Surgery, 2012)

Skin incision starting 11th intercostal space towards the umbilicus ± 15 cm, continue layer by layer while caring for bleeding (The structures incised are : skin, subcutaneous fat, external oblique muscle, internal oblique muscle, transversus abdominis muscle)

Open the lumbo dorsal muscle fascia slightly to the posterior in the posterior axillary line (to avoid tearing the peritoneum) ± 1-2 cm long.

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Separate the peritoneum toward medial side. After the peritoneum is loose, the incision is widened in accordance with the incision on top. Attach spreader

WOUND CLOSURE 

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Partially straighten the table, just enough to allow the edges of the wound to come together but not enough to impede the insertion of sutures. Insert a suction drain to exit through a stab wound.

WOUND CLOSURE 

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Start anteriorly to close the muscles interuptedly using 3/0 PGA material. Close the fascia intureptedly using 2/0 PGA material. Subcutaneous fat is closed using 3/0 plain catgut. Close the skin by 3/0 polypropylene.

POST OPERATIVE PROBLEMS

Earl y

Late

Infection

Fistule

Haematuri a

Hernia

Leakage of urine

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