TRANSPLEURAL RETROPERITONEAL APPROACH TO THE SPINE

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TRANSPLEURAL RETROPERITONEALAPPROACH TO THE
SPINE

• Left-sided skin incision along course of the
  tenth rib
• Divide abdominal muscles (external,internal
  oblique muscles, transversus abdominus muscle) of
  the abdomen in the direction of their fibers
• Dissect peritoneum from inferior surface of
  diaphragm

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TRANSPLEURAL RETROPERITONEALAPPROACH TO THE
SPINE

• Resect 10th rib
• Incise diaphragm 2cm from the rib insertion on
  the spine
• Identify greater splanchnic nerve, ascending
  lumbar/ azygous vein, sympathetic trunk
• Retroperitoneal tissue overlying spine bluntly
  dissected free/ segmental vessels ligated if
  necessary

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Skin incision for the thoracolumbar approach to
the spine.
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EXTERNAL OBLIQUE MUSCLE DIVIDED
PERITONEUM
10th RIB
INTERNAL OBLIQUE AND TRANSVERSE MUSCLES
LATISSIMUS DORSI MUSCLE
Incision through the latissimus dorsi muscle,
external oblique muscle, internal oblique muscle,
and deeper abdominal muscles.
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GREATER PSOAS MUSCLE
EXTERNAL OBLIQUE MUSCLE
PERITONEUM
PERIOSTEUM OVER 10th RIB TO BE DIVIDED
The peritoneum is elevated medially, exposing the
psoas musculature.
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SPLIT COSTAL CARTILAGE OF THE 10th RIB
INTERNAL OBLIQUE AND TRANSVERSE MUSCLES
PERITONEUM
INTERNAL OBLIQUE MUSCLE
EXTERNAL OBLIQUE MUSCLE
THORACIC DIAPHRAGM
The thoracic diaphragm is divided after the 10th
rib is resected, and the costal cartilage is
divided.
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LEFT KIDNEY
PERITONEUM
ABDOMINAL AORTA
COSTAL CARTILAGE OF 10th RIB
DIAPHRAGM DIVIDED AND RETRACTED
SYMPATHETIC TRUNK
LEFT CRUS
L3 NERVE
DEEP ORIGIN OF PSOAS MUSCLE
LEFT LATERAL ARCUATE LIGAMENT
THORACIC DIAPHRAGM DIVIDED
Following separation of the diaphragm, the left
retroperitoneal and retropleural space is
exposed.
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TRANSVERSE COLON
JEJUNUM
LEFT KIDNEY
LIVER
TIP OF SPLEEN
LUMBAR VERTEBRA
A transaxial illustration demonstrating the path
of surgical dissection.