Preoperative Preparation And Patient Position

Anticoagulants, including aspirin, are discontinued five to seven days prior to surgery. Patients with mandatory indications for coumadin are hospitalized for intravenous heparin conversion prior to surgery. Antibiotic prophylaxis, typically with a firstgeneration cephalosporin is administered. Lower extremity sequential compression devices are placed just prior to the induction of general anesthesia. Bowel preparation is not necessary, however, a laxative is given the night before.

The patient is positioned in a flank position with the kidney-bridge elevated to flatten out the lumbar region, and is tilted varying from 45° to 60° for transperitoneal access. For the retroperitoneal approach, the patient is placed in standard lateral decu-bitus kidney position (90°). A slight anterior tilt helps the bowel to be displaced anteriorly by gravity.

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