Application of liver transplant and organ procurement techniques to difficult upper abdominal urological cases.

Surgical approaches used in orthotopic liver transplantation and for multiorgan procurement have been applied to urological cases involving the upper abdomen and retroperitoneum. The method uses the liver transplant incision (bilateral subcostal incision with a cephalad T extension) in combination with a surgical retraction system (Iron Intern and Olivier retractors), providing access for control of the liver and great vessels, and excellent exposure necessary for most difficult urological cases. The incision can be extended if necessary to the lower abdomen or chest. Adjunctive procedures, including mobilization and rotation of the liver, reflection of the pancreas and spleen, control of the intra-abdominal and intracardiac inferior vena cava, and veno-venous bypass, are described.