Aims to avoid muscle splitting and uses retraction of muscle to get access to posterior retroperitoneum.
Generally used in small, young children.
Pros – good if previous abdo surgery, less pain, strong closure, avoid ribs
Cons – limited exposure to ureter, impossible to extend, may be difficult if large kidneys
- Lateral position with break, or prone with pelvis lifted
- Transverse incision between 12th rib and iliac crest along lateral edge of erector spinae
- Skin and subcutaneous tissue divided
- Posterior layer of lumbodorsal fascia and lat dorsi – open
- Retract erector spinae muscles medially
- +/- divide 12th rib costovertebral ligament
- Fused anterior and middle layer of lumbodorsal fascia – open here
- Retract quadratus lumborum medially
- Divide between ilioinguinal and iliohypogastric nerves (iliohypogastric most commonly injured)
- Divide lumbocostal ligament then Gerota’s