Left Nephrectomy Davidoff-Mansfield

Upfront resection was indicated for this localized Wilms tumor in an effort to minimize adjuvant therapy

Preferred incision for nephrectomy is bilateral subcostal, though others may use midline or thoracoabdominal for very large tumors

Care must be taken not to violate the surface of the tumor during dissection

Initial dissection and tumor mobilization is preferably performed laterally rather than starting medially to control vessels early, since occasionally the wrong vessels may be divided

Lateral and posterior dissection planes are generally avascular with only small vessels present which can be controlled easily

Even large Wilms tumors typically only push away adjacent organs but rarely invade them

The adrenal gland does not always need to be taken with the nephrectomy specimen if it appears to be uninvolved with tumor

Despite preoperative imaging that doesn't identify an intravascular tumor thrombus, the vein should be palpated to be sure that no tumor exists within the vein

Some surgeons prefer to take the artery first to avoid congestion of the kidney and tumor, but this has not been found to be a concern since the two vessels can be taken in rapid succession

The artery which generally courses behind the vein is easier to access once the vein has been divided

By saving vessel ligation until the end of the dissection and mobilization of the kidney tumor, there is greater reassurance that they are the correct vessels to take

Periaortic lymph nodes are sampled to ensure appropriate staging of the patient regardless of whether they appear to be pathologically involved or not

This particular tumor weighed almost 2000 grams