title: [Giuliani's method of anterio-lateral transabdominal muscle splitting and nerve preservation for kidney tumors].
abstract: OBJECTIVE
  Anterolateral transabdominal incisions provide good exposure for supramesocolonic and inframescolonic surgery. However, these incisions section and denervate the rectus abdominis, oblique and transversus abdominis muscles with marked loss of active muscle control in a large number of patients. In 1974, Giuliani described an anterolateral transbdominal approach for renal tumours, which provides good visualization and good access to the renal pedicle, as well as good exposure caudally as far as the aortic bifurcation and cranially as far as the diaphragm. The authors report a new anatomical technique using this incision, which splits the muscles and preserves the nerves thereby avoiding the abdominal muscle hypotonia.
  
  
  METHODS
  From March 1996 to March 1998, Giuliani's surgical incision was performed in 35 patients undergoing radical nephrectomy for renal cancer (24 on the left side and 11 on the right side). The mean age of the patients was 63.2 years (range: 42 to 80 years) and the mean follow-up was 11.6 months.
  
  
  RESULTS
  Tone and active control of muscles of the abdominal wall were completely preserved in all of these 35 patients. However, all patients presented a slight sensory loss in the low portion of the transverse skin incision close to the umbilicus, which improved with time and resolved completely in about 50% of cases.
  
  
  CONCLUSIONS
  The mahor advantage of this anatomical incision compared to the conventional technique is to eliminate permanent functional deficits and hypotonia of the abdominal wall. This anatomical approach also allows easy and perfectly safe wound closure in layers, by reconstructing the anterior abdominal wall.
authors.affiliation: Service d'Urologie, Ospedale San Paolo, A.S.L. 2 Savonese, Savona, Italie.
authors.forename: C
authors.initials: C
authors.lastname: Giberti
authors.forename: M
authors.initials: M
authors.lastname: Schenone
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation* / Q000601:surgery*; D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009129:Muscle Tonus; D009392:Nephrectomy / Q000379:methods*
vernacular_title: Voie d'abord antéro-latérale trans-abdominale de Giuliani avec séparation musculaire et préservation nerveuse pour abord des tumeurs du rein.