Dorsal Lumbotomy

• Rolled sheets support the shoulders with patient prone or slightly angled with a small amount of table extension and/or raised kidney rest.

Positioning

• The incision follows the lateral border of the paraspinous musles from the 12th rib to the iliac crest

Incision

• After opening the skin and subcutaneous tissues, the lattissimus dorsi aponeurosis is encountered and incised in the same direction as the skin incision.

lattissimus dorsi aponeurosis is incised in the same direction as the skin incision

• Blunt dissection is used along the lateral border of the sacrospinalis muscle until the lumbodorsal fascia is identified. The medial aspect is bordered by the paraspinous muscles and the quadratus lumborum. The lateral aspect is bordered by the latissiumus dorsi.

lumbodorsal fascia is incised longitudinally

• The lumbodorsal fascia is incised longitudinally with care not to injure the iliohypogastric nerve which lies perpendicular to the incision. This exposes Gerota’s fascia.

Course of the Iliohypogastric nerve

• UPJ and upper ureter are mobilized through a window in Gerota’s fascia.

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