Skin incisions of pyelolithotomy and ureterolithotomy with landmarks from authetic book of urology
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pyelolithotomy skin incision landmarks surgical approach
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ureterolithotomy incision landmarks flank loin approach urology
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pyelolithotomy ureterolithotomy skin incision surgical approach diagram
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open stone surgery kidney ureter incision approach retroperitoneal
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flank incision lumbotomy kidney surgical access landmarks
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ureterolithotomy Gibson incision anterior superior iliac spine pubic tubercle
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The image below shows the ASIS–pubic tubercle relationship used for the Gibson incision in middle and lower ureterolithotomy:
The black diagonal line in this image mirrors the orientation of the Gibson incision: starting at the ASIS, running obliquely downward and medially toward the pubic tubercle, approximately 2 cm above and parallel to the inguinal ligament. (Source: pmc_clinical_VQA)
Key Takeaways
- Pyelolithotomy and upper ureterolithotomy share the same flank (subcostal/12th rib) incision, using the 12th rib, iliac crest, and posterior axillary line as landmarks.
- Dorsal lumbotomy offers a less morbid posterior alternative for pyelolithotomy using the 12th rib and PSIS as boundaries.
- Middle ureterolithotomy is best accessed via the Gibson incision (ASIS → pubic tubercle, 2 cm above inguinal ligament).
- Lower/pelvic ureterolithotomy uses the Pfannenstiel incision (2–3 cm above pubic symphysis) or a lower midline incision.
References: Campbell-Walsh-Wein Urology (12th ed.), Hinman's Atlas of Urologic Surgery (3rd ed.), Smith & Tanagho's General Urology (18th ed.), Novick's Operative Urology.
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