Subcosto-midline Abdominal Incision: A New Incision for Resection of Large Renal Masses with or without Vascular Involvement

Background: Renal cell carcinoma is the third most common urological cancer. Surgical resection is still the mainstay of treatment for this tumor. Here we present a new surgical approach for the management of locally advanced renal cell carcinoma. Methods: We chose ten patients with extensive renal masses. The patient, under general anesthesia after preparation and draping, was placed in the supine position. We made either a right or left classic subcostal incision which was then extended as a midline incision through the linea alba to the lower abdomen. After mobilization of the right ascending or left descending colon, the renal artery and vein were detected, ligated and divided. Next, the involved kidney was released from the adjacent structures and removed, including Gerota’s fascia. Results: The study included 6 men (60%) and 4 women (40%) with a mean age of 57 years. Mean blood loss was 1500 mL and mean operative time was 180 minutes. The patientsʹ surgical wounds were checked for two weeks after the operation; none of the patients developed wound infections or dehiscence. At the time of writing this manuscript, in January 2011, 7 patients (70%) were alive with no evidence of abdominal herniation at the surgical site. Conclusion: A subcosto-midline incision or anterior triangular flap incision is a modified abdominal incision. In our experience, this incision is useful for the resection of locally advanced large renal masses.