Giuliani's muscle splitting and nerve sparing anterolateral transabdominalapproach to kidney tumors.

Objectives : Anterolateral transabdominal incisions provide good exposure f ar supramesocalonic and inframesocolonic surgery. However these incisions s ection and denervate the rectus abdominis, oblique avid transversus abdomin is muscles with marked loss of active muscle control in a large number of p atients. In 1974, Giuliani described an anterolateral transbdominal approac h for renal tumours, which provides good visualization and good access to t he renal pedicle, as well as good exposure caudally as far as the aortic bi furcation and cranially as far as the diaphragm. The authors report a new a natomical technique using this incision, which splits the muscles and prese rves the nerves thereby avoiding the abdominal muscle hypotonia. Material and Methods : From March 1996 to March 1998, Giuliani's surgical i ncision was performed ill 35 patients undergoing radical nephrectomy for re nal cancer (24 an the left side and II on the right side). The mean age of the patients was 63.2 years (range : 42 to 80 years) and the mean follow-up was 11.6 months. Results: Tone and active control of muscles of the abdominal wall were comp letely preserved in all of these 35 patients. However ail patients presente d a slight sensory loss in the low portion of the transverse skin incision close to the umbilicus, which improved with time and resolved completely in about 50% of cases. Conclusion : The mahor advantage of this anatomical incision compared to th e conventional technique is to eliminate permanent functional deficits and hypotonia of the abdominal wall. This anatomical approach also allows easy and perfectly safe wound closure in layers, by reconstructing the anterior abdominal wall.