Retroperitoneal approach
1. Skin incision
Under fluoroscopic control, the L5-S1 disk level is identified.
The skin is incised on the mark.
2. Exposure
After dissection of the subcutaneous tissue, the anterior rectus sheet is incised and the rectus muscle is mobilized to the medial or lateral side, depending on the incision and surgeon's preference.
The posterior rectus sheet is opened and the peritoneum is exposed.
Next the peritoneum is carefully retracted using a hand.
For L5/S1, the vertebrae are accessed in between the vessels bifurcation.
3. Retraction system
A retraction system is mandatory at this point.
4. Closure
A retroperitoneal drain is inserted.
The wound is then closed in layers.
