vickimed
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Boys and girls:
A NBME Question need answer:
A 37 yr-old woman has a renal cell carcinoma confined within the fascia of the right kidney. During nephrectomy usinig a posterolateral approach, which of the following layers is normally incised?
A. Costal pleura
B. Diaphragmatic pleura
C. Parietal peritoneum
D. Transversalis Fascia
E. Visceral Peritonneum
Thanks
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| skyhigh
Forum Guru
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D?
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| vickimed
Forum Newbie
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skyhigh:
Thank you for the answer. I also prefer answer D.
Rds
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| robin082006
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I go with B too
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| star1
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Its D . Kidney are retroperinoneal organ so no incision of peritoneal layers ...
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| druas
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agree with star 1
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| vanshita
Forum Guru
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b?
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| mou
Forum Newbie
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i prefer B ,may be injured accidentally,not normally...!transversalis fascia posteriorly..? pl clarify me
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| giovanni83
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for me it's b too
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| mangoshaikh
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y not c?
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| huzefa
Forum Junior
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D. Kidneys are retroperitoneal.
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| tolito
Forum Fanatic
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D the approach traverses the transversalis muscle and will go thro its fascia too to reach the renal fascia.
B may not be correct because the approach is not transpleural
C the kineys are posterior to the peritoneum ie retroperitoneum so you will get to the kidneys from the back before hitting the peritoneum.
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| ManuNastai
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it's D but to clarify all the other doubts:
if you incise one of the pleural membranes (parietal or visceral) you enter the pleural cavity, my friends. and unless the kidney is in the pleural cavity, you gotta slice  the other one, so A & B are eliminated just like that!
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| tolito
Forum Fanatic
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not quite, remember the superior poles of the kidneys are in contact with the diaphrapgm beneath the 12th ribs. so you could do a transpleural approach, thro the bed of the rib.
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| ManuNastai
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yes, so what? my friend, a transpleural aproach from behind means you first enter the pleural cavity by incising the parietal sheath and then exit it by incising the visceral sheath. is as simple as that..
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