title: Radical nephrectomy with transperitoneal subcostal incision for large and locally advanced tumors of the right kidney.
abstract: BACKGROUND
  Several surgical approaches have been used for radical nephrectomy for large and locally advanced tumors of the right kidney.
  
  
  OBJECTIVE
  To present our experience with radical nephrectomy using a right subcostal incision with a transperitoneal approach in patients with very large tumors of the right kidney.
  
  
  METHODS
  Between 2003 and 2010, 34 patients with very large tumors of the right kidney were submitted to surgery. Eighteen patients underwent a transperitoneal approach with a right subcostal incision (intervention group) and 16 patients were operated on with retroperitoneal flank incision (control group).
  
  
  RESULTS
  No significant complications during surgery were observed in the intervention group; two patients needed blood transfusions of 300 cc during the first postoperative day. In the control group, injury of the renal vein or inferior vena cava (IVC) was a relatively common complication; five patients needed blood transfusions of 300 cc during the first postoperative day.
  
  
  CONCLUSIONS
  A transperitoneal right subcostal incision for radical nephrectomy in patients with large and locally advanced tumors of the right kidney seems to offer better access to the renal pedicle, and to the great vessels of the area as well as better exposure of the organs of the abdominal cavity. This approach could be more useful in cases in which liver involvement is possible.
authors.affiliation: First Department of Urology, University of Athens Medical School, Laiko General Hospital, Ag. Thoma 17, Goudi, 115 27 Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Anastasiou
authors.forename: Theodore
authors.initials: T
authors.lastname: Karatzas
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
authors.forename: Theodore
authors.initials: T
authors.lastname: Tokas
authors.forename: George
authors.initials: G
authors.lastname: Koutalellis
authors.forename: Dionisios
authors.initials: D
authors.lastname: Mitropoulos
authors.forename: Constantinos
authors.initials: C
authors.lastname: Constantinides
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*