After ligation of the renal artery and vein, dissection is carried along the medial aspect of the kidney, maintaining a safe distance from the renal hilum. At the upper pole, the anterior layer of Gerota's fascia is entered and dissection continued close to the kidney to preserve the adrenal gland. The upper pole can be dissected using a combination of sharp and blunt dissection. The use of clips, harmonic scalpel, or endo-gastrointestinal anastomosis is encouraged, as capsular vessels are common at the upper pole. Dissection is then carried to the lateral aspect of the kidney, where blunt dissection is usually sufficient to free the kidney of all attachments except for the ureter.
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