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

Millins 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.

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

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

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

thank you