Background: Renal cell carcinoma is the third most common urological cancer.Surgical resection is still the mainstay of treatment for this tumor. Here we present anew surgical approach for the management of locally advanced renal cell carcinoma.Methods: We chose ten patients with extensive renal masses. The patient, undergeneral anesthesia after preparation and draping, was placed in the supine position. Wemade either a right or left classic subcostal incision which was then extended as a midlineincision through the linea alba to the lower abdomen. After mobilization of the rightascending or left descending colon, the renal artery and vein were detected, ligated anddivided. Next, the involved kidney was released from the adjacent structures andremoved, including Gerota’s fascia.Results: The study included 6 men (60%) and 4 women (40%) with a mean ageof 57 years. Mean blood loss was 1500 mL and mean operative time was 180 minutes.The patients' surgical wounds were checked for two weeks after the operation; noneof the patients developed wound infections or dehiscence. At the time of writing thismanuscript, in January 2011, 7 patients (70%) were alive with no evidence of abdominalherniation at the surgical site.Conclusion: A subcosto-midline incision or anterior triangular flap incision is amodified abdominal incision. In our experience, this incision is useful for the resectionof locally advanced large renal masses.