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Correspondence |

“Intertransversalis” Approach for Laparoscopic Urology: Surgical Anatomy Concerns—Reply

Gang Li, MD; Yeyong Qian, MM; Bingyi Shi, MM
Arch Surg. 2012;147(10):980-982. doi:10.1001/archsurg.2012.2221.
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We have read the letter by Dr Petros Mirilas concerning the intertransversalis fascia (TF) approach and appreciate his comments. However, we do not agree that the concept of a bilaminar TF is outdated. Although some scholars state that the TF is a single-layer structure,1 some other scholars,2,3 including Petros Mirilas,4 have described the TF as a bilaminar structure. In our study,5 we observed the 2 layers of the TF not only in laparoscopic operations (see Figures 2-4 in Li et al5) but also in a histological examination (see Figure 6 in Li et al5). That is why we believe that the TF is a 2-layer structure.

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Figure. Intertransversalis fascia approach during retroperitoneal laparoscopic right nephrectomy. A, Working space filled with blood and fiber after balloon dilation in the fascial space between the rectus abdominis muscle and the superficial layers of transversalis fascia (TF). B, Observing the yellow fat between the 2 layers of the TF in the retroperitoneal region. C, Clearing the fat between the 2 layers of the TF. D, Cutting open the deep layer of the TF and perirenal fascia. 1 Indicates the rectus abdominis muscle; 2, torn fiber of the superficial layer of the TF; 3, superficial layer of the TF (covering the interior surface of pubis); 4, Retzius space; 5, superficial layer of the TF (covering the interior surface of the transversus abdominis); 6, fat between the 2 layers of the TF; 7, deep layer of the TF (superficially covering the perirenal fascia); 8, perirenal fascia; and 9, perinephric fat.

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Correspondence

October 1, 2012
Petros Mirilas, MD, MSurg, PhD
Arch Surg. 2012;147(10):980-982. doi:10.1001/archsurg.2012.2210.
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