Surgical principles of incising the renal parenchyma.

Attention, at nephrotomy, to the anatomy of the kidney will guide incision into a less vascular area and will result in less destruction of tissue. Complete exposure and gentleness of control of the renal pedicle are mandatory. Conservative surgery-removing renal lesions and preserving the remaining functioning tissue - is successful when the proper techniques of incision and hemostasis are employed. With proper drainage and control of infection, nephrostomy is not necessary. Three illustrative cases are presented. Full use of the operating room x-ray machine is helpful. Mattress sutures in the plane of the arteries is the commonest method of parenchymal hemostasis. Although helpful, Gelfoam(R) and Oxycel(R) probably predispose to infection which is the commonest cause of secondary hemorrhage.