The Giuliani muscle splitting and nerve-sparing anterolateral transabdominal approach to the kidney.

We report on an anterolateral transabdominal approach to the kidney, which is appropriate when vascular control is important (such as, radical nephrectomy, traumatic renal injury, and difficult nephrectomy). The technique splits muscles and spares nerves and that allows good exposure both downward as far as the aortic bifurcation and upward as far as the diaphragm. This approach has been used in 42 patients during the last 20 months (mean follow-up, 6.5). In all these patients the active control of the abdominal wall muscles has been completely preserved, while, during the period from 1974 to 1994, about half of 434 patients who underwent the same approach, but with muscle and nerve transection, showed abdominal wall relaxation.