Step 4 Dissection of the Upper Pole of the Kidney

An area of Gerota's fascia cephalad to the renal hilum is incised sharply along the anterior aspect of the upper pole, exposing the renal capsule. The surgeon then places his/her left-handed instrument (suction irrigator or Debakey forceps) next to the capsule and retracts medially. This will develop the plane to dissect the adrenal gland from the upper pole of the kidney. The harmonic scalpel is used here, because it easily coagulates small, friable perforating vessels that may be traveling to the adrenal gland.

During dissection of the upper pole of the kidney, upper pole renal vessels may be encountered and potentially injured. Despite potential identification of these vessels on preoperative computed tomography arteriography, meticulous dissection is necessary to prevent injury.

Next, the upper pole is elevated with the surgeon's left hand, allowing the harmonic scalpel to divide the posterior upper pole attachments.

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