A new understanding of the anatomic structure of posterior abdominal wall in retroperitoneal laparoscopic renal surgery

Abstract

Objective To provide reliable technical method by identifying referential anatomic landmarks for retroperitoneal laparoscopic renal surgery,with respect to the renal hilum and renal artery.Methods The regional anatomy of the posterior abdominal wall was studied in 35 cases of retroperitoneal laparoscopic renal surgery from January to August 2010.These included 27 cases of renal cancer,6 cases of renal pelvis cancer and 2 cases of renal tuberculosis.Distended the retroperitoneal space using balloon dilation along with sharp and dull dissection.We recorded the forms and positions of the posterior abdominal cavity's anatomical landmarks and evaluated the relationship between each anatomical landmark with respect to the renal hilum and renal artery.Results The perirenal fascia posterior layer and perinephric fat on the renal side were observed,and several anatomical landmarks gradually appeared on the posterior abdominal wall.The diaphragm extended across the upper retroperitoneal space near the superior pole of the kidney,and the psoas major and the quadratus lumborum muscles were located at the lower retroperitoneal space,near the inferior part of the kidney.The intersection of the upper diaphragm muscle with the lower psoas major and quadratus lumborum muscles were bordered by the lateral and medial arcuate ligaments.The lateral arcuate ligament arched across the upper part of quadratus lumborum,while the medial arcuate ligament arched across the upper part of psoas major.The medial arcuate ligament points extended towards the upper border of the renal hilum.These landmarks enable us to locate the position of the kidney,reach the renal hilum and identify the renal vessels in all 35 cases.Conclusions The relative position of the muscles and ligaments of the posterior abdominal wall are consistent and can be clearly seen under retroperitoneoscopy.Based on the position of the diaphragm and psoas major,the kidney can be located.In addition,based on the position of the medial arcuate ligament,the renal hilum and renal artery can be located.Assistance from these anatomical landmarks will simplify the retroperitoneal laparoscopic renal surgery. Key words: Laparoscopes; Nephrectomy; Anatomy, regional