Anatomical basis of lumboscopy

Area of Science:

• Urology
• Surgical Anatomy
• Minimally Invasive Surgery

Background:

• Lumboscopy is increasingly used for upper urinary tract operations, necessitating a thorough understanding of retroperitoneal anatomy.
• The inferior approach to the renal pedicle during lumboscopy presents unique anatomical challenges compared to open surgery.

Purpose of the Study:

• To describe the vascular anatomy of the retroperitoneal spaces relevant to lumboscopy.
• To define critical anatomical landmarks for safe lumboscopic dissection of the renal pedicle.

Main Methods:

• Anatomical study using five cadavers.
• Analysis of surgical images to identify vascular structures and landmarks.

Main Results:

• Identification of the psoas major muscle is key to locating the renal pedicle and major vessels.
• The renal vein and its branches are encountered first during renal pedicle dissection.
• Potential confusion exists between the reno-hemi-azygo-lumbar trunk and renal vein on the left side, and the trunk can obscure the renal artery.
• On the right side, the inferior vena cava aids in identifying gonadal, renal, and suprarenal veins.

Conclusions:

• Lumboscopy requires distinct anatomical landmark identification compared to open surgery.
• Understanding potential vascular confusion, particularly on the left, is vital for surgical safety.
• Precise anatomical knowledge facilitates successful lumboscopic upper urinary tract procedures.