title: Dorsal Lumbotomy Incision for Partial Nephrectomy in Patients With Small Posterior Renal Masses.
abstract: OBJECTIVE
  To describe our single-surgeon experience with dorsal lumbotomy, an uncommonly utilized muscle-sparing incision, for open partial nephrectomy.
  
  
  METHODS
  We retrospectively identified patients who underwent partial nephrectomy through dorsal lumbotomy incision by a single surgeon from September 2012 through April 2014. Clinicopathologic characteristics were recorded along with early postoperative outcomes including hospital length of stay and narcotic requirement.
  
  
  RESULTS
  Twenty-four patients were identified for analysis. Median operative time was 71 minutes (interquartile range [IQR]: 63-91 minutes), and median estimated blood loss was 250 mL (IQR: 100-438 mL). Median length of stay was 1.2 days (IQR: 0.94-2.0 days) and median narcotic requirement was 17 mg of oral morphine equivalents (IQR: 4.9-43 mg). Overall perioperative complication rate was 25% including 1 major (Clavien III-V) complication.
  
  
  CONCLUSIONS
  Partial nephrectomy via dorsal lumbotomy incision is a safe and feasible option for small posterior renal masses when performed by an experienced surgeon. The drawbacks of this approach are limited access to the renal hilum and risk of injury to the iliohypogastric or subcostal nerves. Dorsal lumbotomy is associated with postoperative outcomes equivalent to or better than standard operative approaches and should be considered a viable surgical approach in selected cases.
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, PA. Electronic address: ginsburgle@upmc.edu.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Tennyson
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Lyon
authors.affiliation: Division of Urology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Farber
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Andres F
authors.initials: AF
authors.lastname: Correa
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hrebinko
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay / Q000639:trends; D008161:Lumbosacral Region; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology