Identification of the Lower Pole

After mobilization of the colon, Gerota's fascia is seen covering the renal outline. Using sharp and blunt dissection through Gerota's fascia in a craniocaudal direction, the lower pole is identified overlying the psoas muscle. The left-hand instrument is used to retract the lower pole in a lateral direction (that is, toward the abdominal wall), thus stretching the overlying tissue that is then divided by the right-hand instrument while advancing in the direction of the pedicle. A large window is opened up between the lower pole, psoas, and the kidney's medial attachments.

Occasionally, the surgeon encounters severe perinephric inflammatory reaction. In this case, the plane outside Gerota's fascia is often the better plane of dissection, and a radical excision may be the safest and easiest procedure, irrespective of the nature of the pathology.

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