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PubMed1984

Mechanism of rectal contraction mediated by sympathetic efferents from rectoanal pelvic afferents in guinea pigs.

In guinea pigs whose pelvic nerves were bilaterally sectioned, afferent stimulation of rectoanal branches of the pelvic nerve (PAS) could produce an intense contraction in the rectum similar to propulsive contractions elicited during defecation. The mechanism of this reflex was analyzed. Rectal contraction by PAS was abolished after transecting the spinal cord at T13 or sectioning the lumbar splanchnic nerves (LSN) or lumbar colonic nerves (LCN), but was unaffected by severing the intermesenteric and hypogastric nerves. Rectal contraction induced by PAS was abolished peripherally by atropine, guanethidine or yohimbine, while propranolol had no affect. Yohimbine antagonized the inhibitory effect of LSN or LCN stimulation on atropine-sensitive rectal contractions. It may, therefore, be concluded that PAS blocks the inhibition, by LCN efferents acting through alpha-adrenoreceptors, of cholinergic neurons in the myenteric plexus, thus facilitating recto-rectal propulsive contractions initiated by the defecation reflex.

Anal Canal↗

PubMed1986

[Syndrome of perforating lateral branches of the subcostal and ilio-hypogastric nerves. An unrecognized cause of hip pain].

The authors report 10 cases of pain in the outer surface of the hip related to damage of the perforating lateral branch of the subcostal or ilio-hypogastric nerve, which innervate this region. Anatomic investigation showed that there was a possibility of canal neuropathy, the possible mechanisms and signs of which are discussed. In general, treatment consisted of local infiltrations, but one patient underwent surgery with highly successful results.

Arthritis↗

PubMed1998

Sympathetic innervation of the upper and lower regions of the uterus and cervix in the rat have different origins and routes.

The origins and routes of the postganglionic sympathetic nerve supply to the upper and lower uterus and to the cervix were investigated in the rat by using denervation procedures combined with immunohistochemistry and retrograde tracing. The sympathetic nerve fibers of the upper part of the uterus arise from the ovarian plexus nerve. They mainly originate (90%) from neurons of the suprarenal ganglia (SRG) and of the T10 to L3 ganglia of the paravertebral sympathetic chain. Fluoro-Gold injections into different regions of the upper uterus showed that the SRG neurons mainly provide innervation to the tubal extremity (52%) rather than to the uterine portion below this area (26%). Very few neurons of the celiac ganglion or the aorticorenal ganglia participated in this innervation. Most of the sympathetic innervation of the lower uterus and the cervix (90%) originates from neurons of the paravertebral ganglia T13 to S2, principally at the L2-L4 levels. By using immunocytochemistry, we show that very few tyrosine hydroxylase-positive neurons of the pelvic plexus project to these areas, where they represent only 3% of the sympathetic nerve supply. Again, very few neurons of the inferior mesenteric ganglion (IMG) supply the lower uterus and the cervix. The comparison between retrograde tracing experiments in intact animals and after the removal of the IMG shows that very few sympathetic postganglionic axons from the paravertebral chain pass through the IMG to reach the lower uterus and the cervix. In contrast, these axons mainly project to splanchnic nerves bypassing the IMG to connect with the hypogastric nerves. In addition, some axons supplying the lower uterus follow the superior vesical arteries and then reach the organ. Taken together, these results show that the upper region of the uterus receives a sympathetic innervation that is different in origin and route from that of the lower uterus and the cervix. Such a marked region-specific innervation suggests that nerve control of the myometrial activity may be functionally different between the oviduct and the cervical ends of the uterus.

Animals↗

PubMed1982

Substance P-immunoreactive peripheral branches of sensory neurons innervate guinea pig sympathetic neurons.

The presence of substance P-immunoreactive (SPI) varicose nerve networks and nerve fiber bundles in guinea pig prevertebral sympathetic ganglia has been confirmed by fluorescence immunohistochemistry. No SPI neurons have been found in sympathetic ganglia, including lumbar paravertebral ganglia. Peroxidase-antiperoxidase immunocytochemical methods have shown that SPI nerve terminal varicosities in the inferior mesenteric ganglion (IMG) form morphologically identifiable synapses on dendritic shafts. Cutting the intermesenteric nerve produces no obvious change in SP immunoreactivity in the IMG; cutting the lumbar splanchnic nerves produces nearly total depletion which becomes virtually complete if the two lesions are combined; SP immunoreactivity accumulates in the central ends of the lumbar splanchnic nerves and in the cranial end of the intermesenteric nerve. Cutting hypogastric nerves or colonic branches of the IMG leads to accumulation of SP immunoreactivity in their ganglionic stumps and to build-up (colonic nerve lesion) rather than depletion of SP immunoreactivity in the IMG. Capsaicin treatment leads to total loss of SP immunoreactivity from the prevertebral ganglia and dorsal root ganglia, severe depletion in laminae I and II and dorsolateral fasciculus of the spinal cord, and total loss from perivascular and paravascular networks of the ileum and mesentery, with sparing of the SP immunoreactivity of the enteric nerve plexuses. Capsaicin is thought to deplete sensory neurons selectively. Removal of the spinal cord below T7 without damage to the dorsal root ganglia leaves the intraganglionic SPI nerve networks and bundles intact. We conclude that these are derived from peripheral processes of sensory neurons and we propose that the SPI synapses in the IMG arise from collateral branches of these sensory peripheral processes. This implies a novel role for these processes, in forming intraganglionically in the prevertebral ganglia synapses which may take part in the reflex control of the viscera, independently of the central nervous system.

Animals↗

PubMed1995

Choline acetyltransferase-immunoreactive neurones in a prevertebral sympathetic ganglion, the inferior mesenteric ganglion.

Using immunohistochemical techniques a small population of choline acetyltransferase (ChAT) immunoreactive (IR) neurones has been identified in the inferior mesenteric ganglion (IMG) of guinea pig (4.6% of all neurones), ferret (6.4%) and rat (0.4%). A detailed study in the guinea-pig IMG revealed that the vast majority of cholinergic neurones did not express tyrosine hydroxylase (TH)-IR, indicating that they were non-catecholaminergic. The cholinergic neurones were significantly larger than the TH-positive neurones. The majority of the ChAT-IR cells (64%) was observed in small clusters which were consistently located in the caudal lobe of the IMG close to the entry of the hypogastric nerves. 83% of the ChAT-IR cells also contained neuropeptide Y (NPY). Since the vast majority of TH-negative cells were ChAT-positive (94%), the TH negativity was taken as an indirect indication for ChAT-IR. NPY-IR, somatostatin (SOM)-IR and vasoactive intestinal peptide (VIP)-IR were found in both the TH-IR cells (22, 84 and 1%, respectively) and the putative cholinergic population (95, 84 and 70, respectively). Thus the majority of cholinergic neurones in the IMG were likely to contain NPY, SOM and VIP. TH-IR cells exhibited an extensive innervation of fibers immunoreactive for ChAT, VIP, ENK and NOS. In contrast, only a sparse plexus of ChAT-, ENK-, NOS-, NPY- and SOM-positive fibres was found around the TH-negative cells. VIP-IR fibres did not appear to innervate ChAT neurones.

Animals↗

PubMed1995

[Penile block. Block of ilio-inguinal and iliohypogastric nerves in children. Techniques, indications, advantages and adverse effects].

Peripheral blocks as penile blocks, ilio-inguinal ou ilio-hypogastric nerve blocks provide an useful alternative to caudal block in children, especially for penile surgery, herniotomy, and orchidopexy, frequently performed at this age. A precise anatomic location and a strict technique increase the success rate of these blocks. Complications are rare. Postoperative analgesia in ambulatory surgery is one of the best reasons to select these techniques. In addition they avoid prolonged motor effects observed with epidural anaesthesia.

Child↗

PubMed2000

Sympathetic efferent pathways projecting to the prostate in the dog.

BACKGROUND: The laterality of the signals passing through the splanchnic nerves to each lobe of the prostate has not been studied. METHODS: Bilateral distribution of sympathetic signal to both lobes of the canine prostate was determined by measuring contraction of the prostate by stimulation of thoracolumbar splanchnic nerves with or without transection of unilateral hypogastric nerve (HGN). RESULTS: The 2nd-5th lumbar splanchnic nerve (LSN) stimulation elicited prostatic contraction. Twenty-five of 27 right LSN stimulations elicited contraction of the lobe, 21 bilaterally and 4 unilaterally. Twenty-three of 25 left LSN stimulations elicited contraction of the lobe, 22 bilaterally and one unilaterally. The above stimulations did not elicit a dominant response in the lobe of the stimulated side. After transection of the right HGN, right and left LSN stimulation elicited contraction of the lobe bilaterally and did not induce dominant response in the lobe of the non-lesioned side. After transection of the left HGN, similar results were obtained. CONCLUSIONS: The results indicate that each of the LSNs sends signals to bilateral lobes via multiple routes with two crossing sites at the level of the caudal mesenteric plexus and prostate, and that the signals elicit contraction of the lobe without a dominant side.

Animals↗

PubMed1989

Neuropeptide Y, peptide YY, and sympathetic control of rectal tone and anal canal pressure in the cat.

Sympathetic mechanisms in the regulation of rectal tone and anal canal pressure have been investigated in the cat. Immunohistochemical studies demonstrated neuropeptide Y-like immunoreactivity in noradrenergic cell bodies of the inferior mesenteric ganglion, in nerve endings in the circular smooth-muscle layers of the rectum and internal anal sphincter, in the myenteric plexuses, and around blood vessels and anal glands. Peptide YY-like immunoreactivity was demonstrated exclusively in endocrine cells of the rectal mucosa. By radioimmunoassay the amount of neuropeptide Y in the inferior mesenteric ganglion was found to be 28.5 (17.8-66.6) pmol g-1, in the rectum 0.8 (0.7-1.6) pmol g-1, and in the anal canal region 0.8 (0.5-1.0) pmol g-1 of tissue. Neuropeptide Y (4-80 pmol kg-1 min-1 intravenously) and peptide YY (1-25 pmol kg-1 min-1 intravenously) increased rectal tone and anal canal pressure. The effects were not inhibited by guanethidine, phentolamine, or propranolol. Noradrenaline (100-1000 pmol kg-1 min-1 intravenously) increased rectal tone and anal canal pressure. These effects were blocked by phentolamine and propranolol. Electric stimulation of the lumbar colonic nerves and the hypogastric nerves (8 Hz) increased rectal tone and anal canal pressure. After propranolol and phentolamine the responses partly remained. On lumbar colonic nerve stimulation the remaining responses of the rectum and anal canal were 60% (40-68%) (p less than 0.05) and 20% (15-29%), respectively, whereas on hypogastric stimulation the remaining rectal and anal responses were 32% (20-42%) (p less than 0.05) and 31% (20-47%) (p less than 0.05). Further administration of guanethidine abolished the remaining responses of the rectum and anal canal. Since neuropeptide Y is present in sympathetic neurons and mimics non-adrenergic responses to nerve stimulation, this peptide is a transmitter candidate for the effects resistant to adrenergic blocking agents but sensitive to guanethidine. Peptide YY may also play a role in sphincter control, but it cannot be excluded that it activates mechanisms similar to those activated by neuropeptide Y.

Adrenergic Agonists↗

PubMed1996

[L5-S1 herniated disk migrated to the anterior part of the right sacral wing with compression of the right lumbosacral roots].

PURPOSE OF THE STUDY: The goal of this study was to report an exceptional case of far lateral and anterior disc herniation at L5-S1 level. CASE REPORT: A 47 year-old man presented a right L5 radicular pain with motor deficit of tibialis anterior and extensor hallucis longus resisting to medical management. Standard X-rays showed a degenerative process of L5-S1 disc. The CT scan was at first considered as normal. The myelogram was normal. A second study of the CT scan showed an opacity next to the L5 right root in front of the sacral wing. A discography combined with CT scan was then performed showing the migrated herniated disc from L5-S1 to the anterior part of the right sacral wing in contact with L5 root. RESULTS: Surgery was performed by transperitoneal approach and needed a difficult dissection of hypogastric vessels. The herniated disc was found behind the L5 root. A L5-S1 disc excision and arthrodesis with iliac grafts were performed. The result has been very good with relief of the pain and recovery of the palsy within a month. CONCLUSION: The lecture of a CT scan should include the far extraforaminal zone if there is no compression in the spinal canal. Such an anterior migration of an herniated disc has not been already described as far as we know.

Diskectomy↗

PubMed1978

Slowly-developing depolarization of neurones in the guinea-pig inferior mesenteric ganglion following repetitive stimulation of the preganglionic nerves.

Intracellular recordings were made from cells of the isolated guinea-pig inferior mesenteric ganglion. Stimulation of both hypogastric nerves at 30 Hz for 2 sec caused a slowly developing depolarization (SD) and fall in cell input resistance which reached a peak 10-30 sec after the end of stimulation. The amplitude of the SD was increased in a graded manner if the stimulus voltage was increased. The SD was unaffected by tubocurarine, atropine or guanethidine, but was blocked by removing external Ca. These results suggested that the SD was caused by the release of some substance from a large number of nerve terminals.

Animals↗

PubMed2002

Effects of extrinsic autonomic inputs on expression of c-Fos immunoreactivity in myenteric neurons of the guinea pig distal colon.

c-Fos protein is a nuclear protein coded by c-fos proto-oncogene subsequent to synaptic activation of the neurons. We used immunohistochemical methods to visualize the expression of c-Fos protein in myenteric neurons of the guinea pig distal colon and examined the effects of the extrinsic autonomic inputs on the enteric circuits. No c-Fos immunoreactivity was observed in the colonic segments fixed immediately after removal from the animal body. A number of c-Fos-immunoreactive nuclei of myenteric neurons, however, appeared in all preparations that were incubated in Krebs solution in vitro (n=10). Application of tetrodotoxin (0.2 microM) abolished the expression of c-Fos-immunoreactivity (n=6), but hexamethonium (100 microM) failed to decrease the number of c-Fos-positive neurons despite a complete suppression of spontaneous peristaltic movements (n=5). Neither the electrical stimulation (n=8) nor the severing of the pelvic nerves (n=5) changed the number of c-Fos-positive neurons. Application of clonidine, an alpha(2)-agonist, (0.1 microM) abolished the expression of c-Fos protein in all preparations (n=5), while denervation of the sympathetic fibers in the lumbar colonic and hypogastric nerves in vivo increased the number of c-Fos-positive neurons (n=5). The results indicate that the enteric circuit in the distal part of the gastrointestinal tract is under tonic inhibition by the sympathetic nervous system from the lumbar spinal cord. c-Fos immunoreactivity expressed in the colonic preparations in vivo might be the results of enhanced activation of non-nicotinic receptors after removal of the sympathetic inhibition.

Adrenergic alpha-Agonists↗

PubMed1995

[Effects of low anterior resection on colonic motor activity and defecation. An experimental study].

The functional disorder of defecation after low anterior resection (LAR) was studied from the aspect of colonic motility in an experiment with dogs using a strain gage transducer, and the following results were obtained: 1) In early phase after LAR, the frequency of the colonic contractile waves increased at the proximal and distal sites of the anastomosis in both subgroups of dogs denervated and innervated of hypogastric and pelvic nerves. The increase was more remarkable at the distal site of the anastomosis. Also, the contractile waves were not propagated across the anastomosis. 2) After LAR, strong colonic contractions occurred during defecation only at the distal anastomosis. Various patterns of contraction time required for defecation were demonstrated as compared to a single pattern in control dogs. 3) The frequency of the occurrence of colonic contractile waves and the propagation of the contraction tended to be normalized with time after LAR both in denervated and innervated groups, though the recovery was faster in the latter subgroup. 4) The frequency of defecation increased after LAR both in denervated and innervated groups compared to be in the control dogs, though more remarkable in the denervated groups. Although tended to be gradually normalized with time after LAR, the colectomized dogs required a long time for normalization of the frequency of defecation. These results suggested the significant effect of reduction in reservoir space and disturbed continuity of intramural plexus caused by colectomy. Less severity, however, of functional disorder of defecation and earlier recovery from colonic motility disorder in the subgroup of the dogs innervated of autonomic nerves indicated usefulness of retaining autonomic nerves in colectomy.

Animals↗

PubMed1987

Organization of lumbar spinal outflow to distal colon and pelvic organs.

The lumbar sympathetic outflow projects through the lumbar splanchnic, lumbar colonic, and hypogastric nerves (and to a lesser degree through the sacral sympathetic chain and pelvic nerves). It is thought to be involved in the regulation of the storage and evacuation functions of the following three organ systems: lower urinary tract, hindgut, and reproductive organs. In addition, it controls vascular resistance and capacitance. Thus the target tissues of the postganglionic neurons are vascular smooth muscle, visceral smooth muscles, probably secretory epithelia, and also neurons in the enteric nervous system and the pelvic ganglia. The preganglionic neurons are situated in the caudal part of the spinal representation, neurons associated with the colon being located rostral to those associated with the pelvic organs. Most lie medial to the classical intermediolateral cell column that may contain mainly vasoconstrictor neurons. Most (if not all) preganglionic neurons are cholinergic; some also contain an identified peptide. Most of the postganglionic neurons are situated in the inferior mesenteric ganglion (or equivalent structures); again, those projecting to the colon lie rostral to those projecting to the pelvic organs. Others lie in intercalated prevertebral ganglia, in the pelvic plexus, and in sacral paravertebral ganglia. The majority is noradrenergic, and most also contain one or several peptides, the topographical distribution of which appears to characterize functional subgroups of neurons. The terminations of noradrenergic axons in many pelvic organs probably make close contact with both vascular and nonvascular effectors. In the colon, most endings are located in the enteric plexuses. The responses of these organs to electrical stimulation of visceral nerves, and their reflex responses (together with those observed in the efferent axons of visceral nerve trunks) to electrical and natural stimulation of afferent fibers, lead to the general conclusion that several distinct classes of pre- and postganglionic neurons exist. 1) Vasoconstrictor neurons demonstrate ongoing activity with cardiac rhythm and appropriate reflexes to stimulation of cardiovascular afferent receptors and respond only weakly to natural stimulation of visceral receptors. 2) MR neurons respond to visceral stimuli but are not influenced from arterial baro- and chemoreceptors. These show at least two different response patterns consistent with their separate involvement in the reciprocal behavior of the colon and bladder. 3) Other neurons are silent in anesthetized animals and do not respond to any stimuli used thus far.(ABSTRACT TRUNCATED AT 400 WORDS)

Afferent Pathways↗

PubMed2005

Retzius' space haematoma after spontaneous delivery: a case report.

We report a case of a haematoma of the Retzius space after spontaneous uncomplicated delivery. In the postpartum period, the patient complained of urinary retention and pain in the hypogastric region radiating to her left hip and leg. The ultrasound examination showed the presence of 160 x 100 x 80 mm confluent solid and liquid areas with peripheral vascularization. At exploratory laparotomy a haemorrhagic infiltration was found in Retzius' space and the anterior wall of the bladder, which appeared thickened and swollen below the peritoneum. We tried to drain the haematoma, however, we failed to drain it completely because of the large blood infiltration in the bladder wall. Clinical and ultrasound follow-up examinations showed a progressive reduction of the haematoma which completely disappeared nine months later. The haemodynamic changes occurring during pregnancy and labour, associated with strong mechanical stress, seem to be among the major causative factors of haematoma formation. Moreover, the venous load in the pelvic vascular system is increased during pregnancy; a stress-induced increase in venous blood pressure might play a prominent role, especially in cases of venous ectasia, where the resistance of blood vessel walls is reduced. Intraoperative evidence seemed to suggest a haemorrhage secondary to the rupture of the venous vessels in the Santorini plexus. The rupture was probably caused by the thrust of the fetal head, associated with abnormality or fragility of the blood vessels, or by some pathologic changes occurring in the anatomical structures during pregnancy, which could not be accurately defined because of the severity and degree of the haematoma infiltration found intraoperatively.

Abdominal Cavity↗

PubMed1996

[Damage to the inguino-femoral nerves in the treatment of hernias. An anatomical hazard of traditional and laparoscopic techniques].

Laparoscopic techniques currently constitute an alternative proposed for the repair of hernias of the inguinofemoral region. Nerve injuries have led some teams to recommend technical principles based on the anatomical relations of these nerves with the subperitoneal fascia transversalis and inguinal fossae. An anatomical study consisting of dissection of nonembalmed cadavres, allowed, after evisceration, dissection of the lumbar plexus and its terminal branches, particularly those supplying the inguinofemoral region: iliohypogastric and ilio-inguinal nerves, the genitofemoral nerve, the femoral nerve and the lateral cutaneous nerve of the thigh. Via transperitoneal laparoscopy, the posterior surface of the anterior abdominal wall is centered on the deep inguinal ring, containing testicular vessels and the vas deferens. This deep inguinal ring receives the genitofemoral nerve. Medially, the anterior parietal peritoneum describes three folds formed by the outline of the epigastric artery, umbilical artery and urachus on the midline. The outline of Hesselbach's ligament separates the deep inguinal ring from Hesselbach's triangle, the zone of weakness of direct inguinal hernia. The iliac psoas muscle pass laterally underneath the inguinal ligament, while the external iliac vessels, subsequently becoming the femoral vessels, are located medially. Pectineal ligament lies on the posterior surface of the femoral ring between the umbilical artery and the epigastric artery. Installation of an abdominal wall prosthesis, either transperitoneally or retroperitoneally, must be centered on the deep inguinal ring, and its solid sutures are located medially to the pectineal ligament and anterior abdominal wall. On the other hand, the nerves at risk of being damaged are situated laterally: the ilio-inguinal and ilio-hypogastric nerves in the plane between external oblique and internal oblique above the anterior superior iliac spine, lateral cutaneous nerve of the thigh under the inguinal ligament close to the anterior superior iliac spine, genitofemoral nerve with the spermatic cord in the deep inguinal ring and femoral nerve underneath the inguinal ligament with the psoas muscle lateral to the external iliac artery. No stapling must be performed under the plane of the inguinal ligament to avoid damage to the femoral vessels and lateral to the deep inguinal ring to avoid nerve damage.

Femoral Nerve↗

PubMedDate not supplied

The origin and distribution of neurons with projections passing through the inferior mesenteric ganglion of the guinea-pig.

Retrograde tracing with the fluorescent dye, Fast Blue, was used to examine the origin and distribution of neurons whose axons project through the inferior mesenteric ganglion (IMG) of the guinea-pig. These studies were performed by applying the tracer to (a) the rostral cut-end of the hypogastric nerves and (b) the caudal cut-end of the inter-mesenteric nerve (IMN). After application of tracer to the hypogastric nerves retrogradely labelled cell profiles were observed in the IMG and the superior mesenteric ganglion (SMG). The number of labelled cell profiles in the SMG was consistently about 15% of the number in the IMG. In only one of seven animals tested were labelled cells seen in the wall of the colon. Application of tracer to the IMN labelled cells in the IMG and in the wall of the colon. The distribution of the labelled enteric neurons was skewed towards the anal end of the colon. These results confirm that postganglionic sympathetic neurons in the SMG project axons through the guinea-pig IMG and describe the colonic distribution of enteric neurons that project through the IMG and into the IMN.

Amidines↗

PubMed1997

Modulation of feline bladder and distal urethral responses to dorsal sacral root stimulation by intrathecal administration of a kappa 1-opioid agonist.

OBJECTIVES: We examined bladder and distal urethral responses to sacral dorsal root (SDR) electrostimulation with simultaneous intrathecal administration of a kappa 1-opiate agonist. METHODS: Experiments were conducted on 14 spinally intact and 6 chronic spinally transected decerebrated mongrel cats. In the chronically spinalized cats, midthoracic complete spinal cord transection was performed 6 to 8 weeks before the electrostimulation experiments. Sympathetic denervation was carried out by cutting the sympathetic chain and the hypogastric nerve bilaterally. Proximal ends of the cut S1-3DR were stimulated, and bladder pressure and urethral perfusion pressure changes were recorded before and after drug administration. RESULTS: The S2DR electrostimulation in spinally intact cats produced the best vesical contraction, but with dyssynergic urethral response. The magnitude and the pattern of the response changed with the different stimulation parameters. U-50,488H, a selective kappa 1-opiate receptor agonist, decreased significantly the bladder and the urethral responses to S2DR stimulation in spinally intact but not in chronic spinally transected cats. Nor-BNI, a kappa antagonist, reversed these responses in spinally intact cats. CONCLUSIONS: Our results showed that it is feasible to produce bladder contraction with SDR stimulation and suggest that kappa 1 receptors may have a role in bladder and distal urethral reflexes at the suprasacral level.

Animals↗

PubMed2003

[Applied anatomy of the path of retroperitoneal laparoscopy surgery].

OBJECTIVE: To discover the anatomical basis of retroperitoneal laparoscopic surgery. METHODS: Twenty Chinese adult cadavers including 12 and 8 woman were anatomized. The relationship between nerves, vessels of the lateral abdominal wall, retroperitoneal structures and the path of retroperitoneal laparoscopic surgery were measured. RESULTS: In male cadavers, the distance between the iliac crest and lumbar trigonum was 4.02 +/- 1.26 cm on the left, and 3.83 +/- 0.90 cm an the right. The distance between the iliac crest and ilio-hypogastric nerve was 0.82 +/- 0.13 cm on the left and 0.84 +/- 0.08 cm on the right. The distance between the subcostal nerve and XII rib in the posterior axillary line and midaxilla line was 0.79 +/- 0.26 cm, 1.65 +/- 1.12 cm on the left and 0.78 +/- 0.30 cm, 1.59 +/- 1.07 cm on the right respectively. The distance between the ureter of inferior pole of kidney and extra-border of psoas was 2.24 +/- 0.67 cm on the left and 2.19 +/- 0.73 cm on the right. The distance between crossing of the ureter and iliac vessels and extra-border of psoas was 3.91 +/- 0.59 cm on the left and 3.76 +/- 0.53 cm on the right. In female cadavers, the distance between the iliac crest and trigonum lumbale was 3.90 +/- 0.37 cm on the left and 3.87 +/- 0.37 cm on the right. The distance between the iliac crest and ilio-hypogastric nerve was 0.94 +/- 0.06 cm on the left and 0.93 +/- 0.10 cm on the right. The distance between the subcostal nerve and XII rib in the posterior axillary line and midaxilla line was 0.61 +/- 0.14 cm and 1.37 +/- 0.89 cm on the left and 0.64 +/- 0.13 cm, 1.32 +/- 0.95 cm on the right respectively. The distance between the ureter of inferior pole of kidney and extra-border of psoas was 2.00 +/- 0.23 cm on the left and 1.91 +/- 0.13 cm on the right. The distance between crossing of the ureter and iliac vessels and extra-border of psoas was 3.43 +/- 0.31 cm on the left and 3.85 +/- 0.43 cm on the right. CONCLUSIONS: The top of the lumbar trigonum which is 2 cm above the iliac crest selected as the first point and 2 cm inferior to the XII rib in the posterior axillary line selected as the second point is the anatomical basis for retroperitoneal laparoscopic surgery. It can reduce the opportunity to injury nerves, vessels and retroperitoneal structures while making retroperitoneal laparoscopic surgery easy.

Abdominal Wall↗