Bokka Sri Harsha, Sreenivasan Kodakkattil Sreerag, Manikandan Ramanitharan, Lalgudi Narayanan Dorairajan, M Hemachandren, Kalra Sidhartha, Biju Pottakkat
Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND.
Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND.
Cureus. 2020 Oct 18;12(10):e11012. doi: 10.7759/cureus.11012.
Modified Makuuchi (MM) incision is less popular among the urological fraternity as Chevron, subcostal, flank, and midline incisions are commonly used for most of the complex renal and adrenal conditions. We present our experience and report the outcomes of patients operated using this incision.
The records of patients who underwent open surgery for upper abdominal urological conditions using MM incision over the last five years in our department were retrospectively reviewed. Patient demographics, laterality of the lesion, size of the lesion, level of inferior vena caval (IVC) thrombus, intraoperative blood loss, local tumor invasion, need for concomitant hepatectomy, need of diaphragmatic resection, use of self-retaining retractors, operative time, hospital stay, wound-related complications, and readmissions were analyzed.
Some 18 patients underwent open surgery by this incision for various complex renal and adrenal conditions during the study period. Patients included those with large upper pole renal and adrenal masses, renovascular conditions like renal artery aneurysm, renal/adrenal masses with liver and diaphragmatic infiltration requiring hepatectomy, diaphragmatic resections, or IVC thrombectomy. The mean size of renal and adrenal masses was 13.8 (±6.3) cm, mean operative time was 370 (±210.6) minutes, mean blood loss was 1124 (±990.3) mL, and mean hospital stay was 11.65 (±13.2) days. Four patients had surgical site infection (SSI) and one had readmission.
The MM incision can be widely adapted for complex renal and adrenal surgeries and should become a part of the various commonly used incisions by urologists.
改良马库uchi（MM）切口在泌尿外科领域不如人字形、肋下、侧腹和中线切口常用，后几种切口常用于大多数复杂的肾脏和肾上腺疾病。我们介绍我们的经验并报告使用该切口进行手术的患者的结果。
回顾性分析了过去五年在我们科室使用MM切口进行上腹部泌尿外科疾病开放手术的患者记录。分析了患者的人口统计学资料、病变侧别、病变大小、下腔静脉（IVC）血栓水平、术中失血、局部肿瘤侵犯情况、是否需要同时进行肝切除术、是否需要切除膈肌、是否使用自动拉钩、手术时间、住院时间、伤口相关并发症及再次入院情况。
在研究期间，约18例患者通过该切口进行了各种复杂的肾脏和肾上腺疾病的开放手术。患者包括患有巨大肾上极肾脏和肾上腺肿块的患者、肾血管疾病如肾动脉瘤患者、伴有肝脏和膈肌浸润需要进行肝切除术、膈肌切除术或IVC血栓切除术的肾/肾上腺肿块患者。肾脏和肾上腺肿块的平均大小为13.8（±6.3）cm，平均手术时间为370（±210.6）分钟，平均失血量为1124（±990.3）mL，平均住院时间为11.65（±13.2）天。4例患者发生手术部位感染（SSI），1例患者再次入院。
MM切口可广泛应用于复杂的肾脏和肾上腺手术，应成为泌尿外科医生常用的各种切口的一部分。
