Anatomic planes and landmarks in urologic laparoscopy

Abstract

The bladder, urachus and medial umbilical ligaments, vas deferens, iliac vessels, and rectum serve as visible landmarks in the transperitoneal LRP. The exposure of prerectal fat shows the proper anatomical plane of dissection between Denonvilliers' fascia and the rectum. An avascular plane underneath the DVC separating the urethra from the DVC must be dissected, which allows the complete identification of the prostate limits and urethra. The following landmarks should be identified in LRC: the medial umbilical ligaments, the peritoneal folds overlying the ureters close to the bladder, the vas deferens on each side (for male), the posterior cul-de-sac of the rectovesical pouch, and the iliac vessels upon initial inspection of the pelvis. The Toldt line, duodenum, and vena cava are important landmarks to expose renal hilum in right radical nephrectomy. The attachments around spleen, descending colon, and splenic flexure are important landmarks to expose the renal hilum in left radical nephrectomy. The psoas muscle is always an initial landmark and serves as a guide for subsequent longitudinal orientation in the retroperitoneal laparoscopic approach.