[The anterior and transperitoneal approach in the surgery of the kidney and ureter]

Because of the variety of situations encountered in surgery of the kidney and ureter, the methods of approach to these organs need to be diversified. In this context, the authors discuss the place of the anterior and transperitoneal approach, based on a series of 573 cases. Its principal indications are: excision of large kidney tumours or pseudo-tumours, conservative treatment of hydronephrosis, removal of pelvic calculi, staged operations or operations on bilateral lesions, re-operations resulting in secondary nephrectomy or repair of the collecting system. The modalities, advantages and disadvantages are discussed and the authors stress the complications which may result from opening of the peritoneum. Overall, the anterior and transperitoneal approach, in the situations in which it is indicated, is an easy and safe operative technique, superior to the usual sub-peritoneal approaches. Its results are very satisfactory; they should overcome reservations which have surrounded this technique for so long and should give it a definite place beside the classical approaches, which nevertheless remain supreme.