TRANSPERITONEAL APPROACH

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TRANSPERITONEAL APPROACH

• Anterior midline incision or Pfannenstiel
  incision
• Incise posterior peritoneum 2cm right of midline
• Retract adipose and connective tissue with
  superior hypogastric plexus to left
• Ligate middle sacral artery and vein
• Mobilize great vessels to expose spine

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Incision for the transperitoneal approach to the
spine.
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Following opening of the abdomen, the posterior
peritoneum is opened 2cm to the right of midline.
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INFERIOR MESENTERIC ARTERY
SUPERIOR HYPOGASTRIC PLEXUS
RIGHT COMMON ILIAC VEIN
RIGHT COMMON ILIAC ARTERY
RIGHT URETER
SACRAL PROMONTORY
The exposed anatomy anterior to the lumbosacral
junction.