Step 2 Fixation of the Kidney

The patient is placed in a steep, Trendelenburg (head down) position, thereby facilitating cephalad displacement of the kidney. Using either the intra- or the extracorporeal knot-tying techniques, the kidney is fixed high on the posterior abdominal wall. According to surgeon preference, a vertical or horizontal row of sutures may be employed. Initially the upper pole of the kidney is affixed to the psoas or quadratus lumborum muscle with 2/0 nonabsorbable polyester suture on a round-bodied needle. Care must be taken to ensure that the suture only catches the renal capsule without penetrating the renal parenchyma

Two to three further sutures are placed in the similar manner at the middle and lower pole of the kidney (Fig. 1). Once all the sutures are secured, intra-abdominal pressure is decreased to 5 mmHg for inspection of the operative field and port sites for bleeding. After hemostasis is achieved, the ports are removed and port sites closed.

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