Feasibility and Preliminary Outcomes of the Modified Makuuchi Incision in Urologic Oncology: A Single-Surgeon Case
David Nelwan1, Saeed Imam1, Aaron Dahmen1
1Department of Urology, University of South Florida, Tampa, USA.
Introduction:
The modified Makuuchi incision consists of a midline incision originating at the xiphoid process, extending caudally to the supra-umbilical region, then curving laterally as a "J/L" shape between the anterior superior iliac spine and the lowest rib. It affords not only ease of entry but also rapidity of closure, excellent exposure, and compatibility with prior abdominal incisions and any body habitus. Despite the potential benefits of the Makuuchi incision, it has had a limited role in urologic surgery. We present our experience with the utilization of the modified Makuuchi incision for large renal and adrenal tumors at our institution.
Methods:
Sixteen cases utilizing the Makuuchi incision for genitourinary tumors were reviewed, all performed by a single urologist at our tertiary care institution. Data collected included patient demographics and characteristics, intraoperative metrics, and postoperative course.
Results:
Our cohort consisted of seven females and nine males; 12 patients underwent right-sided incision, and four underwent left-sided incision. Twelve patients (75%) had renal cell carcinoma, and four had adrenal pathology. There was renal vein invasion/inferior vena cava thrombus in eight patients (50%). Table 1 summarizes the averages and ranges for the following data points in our 16 cases: patient age, BMI, tumor size, operative time, estimated blood loss, return of bowel function, post-anesthesia care unit oral morphine milligram equivalents (OME), and length of stay. Table 2 lists tumor size, staging, and the level of venous thrombus. There were neither intraoperative complications nor any incision-related postoperative complications.
Conclusions:
The modified Makuuchi incision has been shown to be safe and feasible for large genitourinary tumors, with comparable outcomes to other incisions. Based on our cumulative operative experience, we conclude that the Makuuchi incision represents a feasible and adaptable surgical approach for complex urologic oncology cases and requires broad upper abdominal exposure.
