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Lumb 03
1. TRANSPERITONEAL APPROACH
1) Anterior midline incision or Pfannenstiel incision
2) Incise posterior peritoneum 2cm right of midline
3) Retract adipose and connective tissue with superior
hypogastric plexus to left
4) Ligate middle sacral artery and vein
5) Mobilize great vessels to expose spine
3. Following opening of the abdomen, the posterior
peritoneum is opened 2cm to the right of midline.
4.
5. SUPERIOR HYPOGASTRIC PLEXUS INFERIOR MESENTERIC ARTERY
SACRAL PROMONTORY
RIGHT COMMON
ILIAC VEIN
RIGHT COMMON
ILIAC ARTERY
RIGHT URETER
The exposed anatomy anterior to the lumbosacral junction.
6. SUPERIOR HYPOGASTRIC PLEXUS INFERIOR MESENTERIC ARTERY
SACRAL PROMONTORY
RIGHT COMMON
ILIAC VEIN
RIGHT COMMON
ILIAC ARTERY
RIGHT URETER
The exposed anatomy anterior to the lumbosacral junction.
