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In exposing deeply seated organs, two principles are to be observed: complete exposure of the organ concerned and the least possible destruction of the covering structures compatible with such free exposure. If, in renal surgery, a flank incision is chosen, the proper position of the patient is one of the decisive factors in providing for good accessibility of the kidney.
The available space is framed by two bony structures —above, the edge of the lower costal arch, and below, the crest of the iliac bone. The farther apart these enclosures are forced, the larger the usable interstice will be. The proper widening of the bony frame will best be accomplished by placing the patient in a lateral position and by putting him on an incline in such a way as to cause bulging of the flank concerned.
Unnecessary destruction may be avoided by employing a muscle splitting procedure in lieu
KOLISCHER G, KATZ H. PYELOTOMY, URETEROLYSIS AND EXTIRPATION OF THE KIDNEY: A SPECIAL TECHNIC. JAMA. 1923;80(24):1757–1760. doi:10.1001/jama.1923.02640510013006
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