4. Flank approach
• Standard approach for renal
& upper ureteric stones
open surgery or simple
nephrectomy or partial
nephrectomy.
• Can be used in renal or
adrenal tumors if: small
tumors, obese or unfit
patients.
Subcostal.
Transcostal.
Supracostal (Intercostal).
The patient is in the flank position. Gerota´s fascia is opened
posteriorly, so that the peritoneal cavity is not entered.
By M.A.Wadood , MD, MRCS
5. Anterior Transperitoneal approach
• Standard approach for renal
or adrenal tumors excision.
• Involves:
bilateral subcostal (Chevron)
hemi-chevron
midline incision.
• allows access to the peritoneal
cavity and inspection to rule
out metastasis and/or
extraadrenal disease.
Chevron incision
By M.A.Wadood , MD, MRCS
17. Percutaneous Cystostomy
The bladder must be filled with 400 - 600 ml of saline
until it can be palpable
When the trocar is pushed into the bladder, the obturator is
removed and fluid will escape. Immediatelly must be insert
special catether through the sheat.
By M.A.Wadood , MD, MRCS
22. Inguinal incision
Adult Pediatric
(along skin crease)
• For hernia, hydrocele & undescended testis in children
and radical orchiectomy in adults.
By M.A.Wadood , MD, MRCS
36. Techniques of peritoneal entry
Verrese needle (classical technique) Open (Hasson technique)
through infraumbilical incision
By M.A.Wadood , MD, MRCS