Subperiosteal rib-saving approach to kidney

An operative approach to the kidney is described which takes advantage of the single attachment of the eleventh and twelfth ribs to their vertebral bodies, and an avascular plane that is present in the periosteal bed of the rib. By separation of the posterior attachments, the rib can pivot posteriorly and give a wide exposure of the kidney. By using an approach through the bed of the rib, the vascular supply to the intercostal space is avoided and less operative blood loss occurs. Saving the rib, rather than transecting it, avoids pleural and glove damage during the operation and adds a firmness to the wound not present when the rib is excised.