Challengers I Told Ya ShirtChallengers I Told Ya Shirt
Junx 01
1. TRANSPLEURAL RETROPERITONEAL
APPROACH TO THE SPINE
1) Left-sided skin incision along course of the tenth rib
2) Divide abdominal muscles (external,internal oblique muscles,
transversus abdominus muscle) of the abdomen in the
direction of their fibers
3) Dissect peritoneum from inferior surface of diaphragm
2. TRANSPLEURAL RETROPERITONEAL
APPROACH 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
5. PERITONEUM
INTERNAL OBLIQUE
AND
TRANSVERSE MUSCLES
10th RIB LATISSIMUS DORSI
MUSCLE
EXTERNAL OBLIQUE
MUSCLE DIVIDED
Incision through the latissimus dorsi muscle, external oblique muscle,
internal oblique muscle, and deeper abdominal muscles.
6.
7. GREATER PSOAS MUSCLE EXTERNAL OBLIQUE MUSCLE
PERITONEUM
PERIOSTEUM OVER 10th RIB
TO BE DIVIDED
The peritoneum is elevated medially, exposing the psoas musculature.
8.
9. PERITONEUM
INTERNAL OBLIQUE AND
TRANSVERSE MUSCLES
SPLIT COSTAL CARTILAGE
OF THE 10th RIB
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.
10.
11. COSTAL
CARTILAGE
OF 10th RIB
LEFT KIDNEY PERITONEUM
ABDOMINAL AORTA
SYMPATHETIC
TRUNK
L3 NERVE
DEEP ORIGIN OF
PSOAS MUSCLE
LEFT LATERAL ARCUATE LIGAMENT
DIAPHRAGM
DIVIDED AND
RETRACTED
LEFT CRUS
THORACIC DIAPHRAGM DIVIDED
Following separation of the diaphragm, the left retroperitoneal and
retropleural space is exposed.
12.
13. JEJUNUM
LEFT KIDNEY
TIP OF SPLEEN
TRANSVERSE COLON
LIVER
LUMBAR VERTEBRA
A transaxial illustration demonstrating the path of surgical dissection.
