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Gibson Incision: Indications, Anatomy, and Surgical Steps

Urologic Indications

In urology, a Gibson incision is used for kidney transplantation or as an extraperitoneal approach to the distal ureter.

Gibson incision: the arc-shaped incision starts 2 cm medial to the anterior superior iliac spine and continues to the rectus sheath's lateral border (3 cm cranial to the inguinal ligament).

Patient positioning:

Supine position with slight hyperextension of the lumbar spine.

Surgical Technique of a Gibson Incision

• See fig. gibson incision for the skin incision.
• Divide the external oblique abdominal muscle in the direction of the muscle fibers.
• Transsect the internal oblique and transverse abdominal muscles at the lateral edge of the rectus sheath in the area of their aponeurosis. For a better approach, the lateral edge of the rectus muscle can be incised caudally.
• The inferior epigastric vessels are transected between ligatures.
• Push off the peritoneum cranially and medially with blunt dissection to expose the iliac vessels and ureter.

Wound closure:

Fascial closure in two layers with continuous running (monofilament, elastic, slowly absorbable, suture size USP 0 or 2-0) or interrupted sutures: the first suture reapproximates the internal oblique and transverse abdominal muscle, the second suture closures the external oblique abdominal muscle.

References

J. A. Smith, S. S. Howards, G. M. Preminger, and R. R. Dmochowski, Hinman’s Atlas of Urologic Surgery Revised Reprint. Elsevier, 2019.

  Deutsche Version: Schräger Unterbauchschnitt nach Gibson