Anatomical Study of Abdominal Wall Muscle Innervation to Optimize Retroperitoneal Vascular Approach

Area of Science:

• Anatomy
• Surgical Innovation
• Neuroscience

Background:

• Retroperitoneal approaches in aortic surgery risk abdominal wall weakness and nerve injury.
• Existing research on minimizing nerve damage during these dissections is limited.
• Abdominal wall muscle complications can arise from nerve damage during anterolateral or anteromedial dissections.

Purpose of the Study:

• To detail the anatomical course of abdominal muscle motor nerves.
• To establish the relationship between nerves and anatomical landmarks like ribs.
• To optimize surgical techniques for nerve preservation during aortic procedures.

Main Methods:

• Conducted 12 fresh cadaver dissections.
• Mapped trajectories of intercostal (9th-11th) and subcostal (12th) nerves.
• Recorded nerve distances to midline, umbilicus, and iliac crest.

Main Results:

• The 12th subcostal nerve is the largest; the 11th intercostal nerve has numerous branches.
• Identified nerve communications between the 10th-11th and 11th-12th intercostal nerves.
• Provided precise measurements for nerve projection points and distances to landmarks.

Conclusions:

• Proposed optimal incision lines for nerve preservation: 4cm above umbilicus for 11th nerve, 1cm below for 12th nerve, and <1.5cm from iliac crest for IHN.
• Nerve projection points toward the midline aid in anatomical localization.
• Findings offer valuable data for refining surgical approaches and warrant clinical confirmation.