ANTERIOR LATERAL RETROPERITONEAL APPROACH

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ANTERIOR LATERAL RETROPERITONEAL APPROACH

• Left-sided approach oblique incision between
  twelfth rib and iliac crest coursing anteriorly
  toward the rectus sheath
• Divide latissimus dorsi, external oblique,
  internal oblique, transversus abdominus and
  transversalis fascia
• Elevate peritoneal contents off psoas muscle
  (retract kidney and ureter to right)
• Expose vertebrae as described previously

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Skin incision for anterior lateral
retroperitoneal approach to the spine.
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EXTERNAL AND INTERNAL OBLIQUE MUSCLES DIVIDED
AND RETRACTED
PREPERITONEAL ADIPOSE TISSUE
EXTERNAL OBLIQUE MUSCLE
INTERNAL OBLIQUE MUSCLE
TRANSVERSE MUSCLE
POSTERIOR INFERIOR SERRATUS MUSCLE
LATISSIMUS DORSI MUSCLE
QUADRATUS LUMBORUM MUSCLE
12th RIB
ILIOCOSTAL MUSCLE RETRACTED
The abdominal muscles have been divided,
exposing the preperitoneal adipose tissue.
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ANTERIOR LONGITUDINAL LIGAMENT
URETER
RIGHT MEDIAL CRUS
LEFT MEDIAL CRUS
PERITONEAL CONTENTS
LEFT MEDIAL ARCUATE LIGAMENT
DIAPHRAGM DIVIDED
SYMPATHETIC TRUNK
ILIOINGUINAL NERVE
GREATER PSOAS MUSCLE
The peritoneal contents are bluntly elevated,
exposing the spinal column.