Posted by CLDing on May 14, 1999 at 11:22:51:
In Reply to: Re: Yet another RCC posted by Chit Sin on May 13, 1999 at 23:50:22:
There are some surgeons who routinely do a thoracoabdominal for radical nephrectomy. Jim Fowler of Edinburgh (a good operator) is an example. The surgery is very much easier but it still involves cutting diaphragm, and postoperative chest tubes etc, all adding up to extra cost. I went thoracoabdominal for a while after returning from Edinburgh but have found it unnecessary for the past 13 years. The trick is to do the supra-12 right to the costo-vertebral ligament and divide the c-v ligament so that the rib can swing down easily (I learned from my cardiothoracic boss). If you get to this point, you are at the adrenal bed and the crura.