title: A muscle-sparing modified Gibson incision for hand-assisted retroperitoneoscopic nephroureterectomy and bladder cuff excision--an approach through a window behind the rectus abdominis muscle.
abstract: OBJECTIVE
  To report our technique using a modified muscle-sparing Gibson incision for hand-assisted retroperitoneoscopic nephroureterectomy (HARN) and open bladder cuff excision.
  
  
  METHODS
  Thirty-four patients with upper tract transitional cell carcinoma received HARN and open bladder cuff excision using the modified muscle-sparing Gibson incision-an approach through a window behind the rectus abdominis muscle with the patient in a supine position with the legs extended and abducted at 45-60° with the surgeon standing between the legs of the patient. The window behind the rectus muscle was identified with ease. HARN and open bladder cuff excision were performed uneventfully using this incision. Mean estimated blood loss was 119 mL. Mean operation time was 139 minutes. Morphine was required for pain relief for 1-3 days (mean 16.5 mg). Mean time to oral intake was 1.5 days and to ambulation was 2.1 days. No lower abdominal bulge was found during a 15.4-month follow-up.
  
  
  CONCLUSIONS
  This modified muscle-sparing Gibson incision for retroperitoneal hand-assisted laparoscopic nephrectomy has the benefit of easier retroperitoneal approach of the Gibson incision. Iliohypogastric nerves can be spared under direct vision. By merely retracting and not incising or splitting the rectus abdominis muscle, this incision may decrease wound-related morbidity. This window could be an important portal for hand-assisted laparoscopic surgeries.
authors.affiliation: Department of Urology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
authors.forename: Chien-Hui
authors.initials: CH
authors.lastname: Ou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000601:surgery*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D007001:Hypogastric Plexus; D007676:Kidney Failure, Chronic / Q000150:complications; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods*; D017568:Rectus Abdominis; D012187:Retroperitoneal Space; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000150:complications / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*