RT Journal
A1 Li G, Qian Y, Bai H, et al
T1 INtertransversalis fascia approach in urologic laparoscopic operations
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD February 1
VO 147
IS 2
SP 159
OP 167
DO 10.1001/archsurg.2011.919
UL http://dx.doi.org/10.1001/archsurg.2011.919
AB Objectives 
                  To study the clinical anatomy of the transversalis fascia (TF) and to explore the intertransversalis fascia approach in urologic laparoscopic operations (ULOs).Design 
                  Prospective study.Setting 
                  Two academic hospitals.Other Participants 
                  Data from 1217 urologic laparoscopic or open operations and 10 laparoscopic hernia repairs were analyzed between January 1, 2009, and April 30, 2011. Findings from 3 fresh autopsies were also included.Main Outcome Measures 
                  The anatomy of the TF was studied and the intertransversalis fascia approach was explored in ULOs; furthermore, they were proved in the open operations and fresh autopsies. Photographs were taken from the intertransversalis fascia approach in ULOs, micrographs were obtained to examine the microscopic structure of the TF, and the color atlas of TF anatomy (cross and sagittal sections) was drawn.Results 
                  The TF is a general plane of connective tissue lying between the inner surface of the transversus abdominis and the extraperitoneal fat. It can be divided into 2 layers (superficial and deep), with an amorphous fibroareolar space between them. The intertransversalis fascia approach in ULOs is the approach between the 2 layers of the TF.Conclusions 
                  The intertransversalis fascia approach is described for the first time, to our knowledge. Surgeons can obtain a clean, clear, and bloodless operating space in ULOs using the intertransversalis fascia approach.