Surgical anatomy

The 11th and 12th ribs are floating ribs and related to the upper half of the kidney. They provide useful surface markings for loin incisions, which divide skin, latissimus dorsi muscle, external and then internal oblique muscles. The pleura lies in the upper part of the incision and can be punctured, causing a pneumothorax. The transversus abdominis muscle is then divided and the kidney, surrounded by the

Psoas muscle

Quadratus lumborum muscle

Psoas muscle

Quadratus lumborum muscle

Diaphragm

Right kidney

Transversus abdominus muscle

Adrenal gland

Diaphragm

Right kidney

Transversus abdominus muscle

Liver

Hepatic flexure of colon

Liver

Hepatic flexure of colon

Duodenum

Figure 19.1. (a) Posterior and (b) anterior relations of the kidney.

Adrenal gland

Duodenum

Adrenal gland

Stomach and lesser sac

Tail of pancreas

Figure 19.1. (a) Posterior and (b) anterior relations of the kidney.

Adrenal gland

Stomach and lesser sac

Tail of pancreas

Spleen

Splenic flexure of colon

Left

Spleen

Splenic flexure of colon

Left perinephric fat contained within the Gerota's fascia, lies in the retroperitoneal space (Fig. 19.1). It should be noted that the pleural cavity may be deliberately opened during surgery to improve access to the upper pole of the kidney.

Other common approaches to the kidney include the transabdominal route (e.g. via a subcostal incision) and also laparoscopic approaches which can be either transabdominal or retroperitoneal.

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