Abstract
Background: Modified Makuuchi (MM) incision is less popular among the urological fraternity as Chevron, subcostal, flank, and midline incisions are commonly used for most of the complex renal and adrenal conditions. We present our experience and report the outcomes of patients operated using this incision.Materials and methods: The records of patients who underwent open surgery for upper abdominal urological conditions using MM incision over the last five years in our department were retrospectively reviewed. Patient demographics, laterality of the lesion, size of the lesion, level of inferior vena caval (IVC) thrombus, intraoperative blood loss, local tumor invasion, need for concomitant hepatectomy, need of diaphragmatic resection, use of self-retaining retractors, operative time, hospital stay, wound-related complications, and readmissions were analyzed.Results: Some 18 patients underwent open surgery by this incision for various complex renal and adrenal conditions during the study period. Patients included those with large upper pole renal and adrenal masses, renovascular conditions like renal artery aneurysm, renal/adrenal masses with liver and diaphragmatic infiltration requiring hepatectomy, diaphragmatic resections, or IVC thrombectomy. The mean size of renal and adrenal masses was 13.8 (±6.3) cm, mean operative time was 370 (±210.6) minutes, mean blood loss was 1124 (±990.3) mL, and mean hospital stay was 11.65 (±13.2) days. Four patients had surgical site infection (SSI) and one had readmission.Conclusion: The MM incision can be widely adapted for complex renal and adrenal surgeries and should become a part of the various commonly used incisions by urologists.
Highlights
Complex renal surgeries are usually operated by flank, Chevron, subcostal, midline, and thoracoabdominal incisions whenever an open surgery is deemed mandatory [1]
Some 18 patients underwent open surgery by this incision for various complex renal and adrenal conditions during the study period. Patients included those with large upper pole renal and adrenal masses, renovascular conditions like renal artery aneurysm, renal/adrenal masses with liver and diaphragmatic infiltration requiring hepatectomy, diaphragmatic resections, or inferior vena caval (IVC) thrombectomy
The aim of the present study is to report the utility of Modified Makuuchi (MM) incision in the management of complex upper abdominal urological surgeries and its advantages over the conventional incisions
Summary
Complex renal surgeries are usually operated by flank, Chevron, subcostal, midline, and thoracoabdominal incisions whenever an open surgery is deemed mandatory [1]. The Makuuchi incision consists of an upper vertical midline incision that originates from the xiphoid process, extends caudally up to 5 cm above the umbilicus, and curves laterally as a J along the ninth intercostal space to end at the posterior axillary line [5] This was later modified by Chang, in which the vertical limb remained the same whereas the horizontal limb curves laterally as a reverse L in parallel to the anatomic abdominal skin fold at the level of umbilicus and along the dermatomal distribution of the nerves to end at the midpoint between the lowest rib and the anterosuperior iliac spine [6]. We present our experience and report the outcomes of patients operated using this incision
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