—Wharton1 contended that the outlook in the treatment of malignant tumors of the kidney is improving because of the use of radiation preoperatively to reduce the size and make nephrectomy feasible and because of the transperitoneal approach for removal.The results of lumbar nephrectomy for renal tumor have been poor because these growths, which reach enormous size, are highly vascular, are made up of friable tissue which is characteristically transplantable and have a thin, delicate capsule which is easily ruptured. The mobilization and manipulation necessary before the renal pedicle can be reached and ligated tend to produce hemorrhage, distant metastasis from milking tumor cells into the blood stream and local recurrences from rupture of the capsule. The last structure to be seen and controlled is the renal pedicle, whereas it should be the first.These disadvantages of lumbar nephrectomy are eliminated by the transperitoneal approach, which permits
SCHOLL AJ, JUDD ES, VERBRUGGE J, HEPLER AB, GUTIERREZ R, O'CONOR VJ. A REVIEW OF UROLOGIC SURGERY. Arch Surg. 1936;32(3):544–576. doi:10.1001/archsurg.1936.01180210173009
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