Initial Dissection

With the kidney retracted or tented anterolaterally, a generous longitudinal incision is made in Gerota's fascia, parallel and close to the psoas muscle. This critical maneuver allows access to the renal hilar area. A search for vascular pulsations is initiated. Although gentle, undulating pulsations are characteristic of the inferior vena cava, sharp, well-defined pulsations reveal the location of the fat-covered renal artery or, on the left side, the aorta. Subsequent operative steps depend on the procedure being performed.

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