The eleventh rib transcostal incision: an extrapleural, transperitoneal approach to the upper abdomen

Subperiosteal resection of the eleventh rib with transcostal, extrapleural entrance into the retroperitoneum for exposure of the kidneys or adrenal glands has been well described in the urologic literature. We have used the incision with transperitoneal extension for various procedures in the upper abdomen. The following is a description of our operative technique with suggestions for procedures in which the incision may be used. The incision is ideal for splenectomy, distal splenorenal shunts, resections of the pancreatic body and tail, portacaval shunts, right hepatic lobectomy, and transperitoneal unilateral adrenalectomy.