Operative note 26 Advanced
Laparoscopic nephrectomy
What it does: kidney out, keyhole. Simple or radical.
- Drop the colon off the white line of Toldt. (Toldt's = the peritoneal seam beside the colon.)
- Open the plane between bowel fat and Gerota's.
- Right side: Kocher the duodenum off the IVC. (Reflect it inwards.)
- Find the ureter below the lower pole.
- Follow it + the gonadal vein up to the pedicle. Gonadal vein: to IVC on the right. To renal vein on the left.
- Open Gerota's at the lower pole. Work upwards.
- Artery first, then vein, ureter last. Clips/staples.
- Radical: adrenal + whole Gerota wrapper stay on.
- 2026 update: Robot-assisted is the usual UK platform. Same steps.
- 2026 update: T1a/T1b tumour: partial nephrectomy is the default where feasible (EAU RCC).
From the UroRef Operative Quick Guide.