Left Para Aortic Dissection

■ Lateral and upward the peritoneum is separated from the psoas muscle to enlarge the working space.

■ The peritoneum and the duodenum are separated cranially from the anterior aspect of the great vessels until the left renal vein is completely visible.

■ The lymphatic fat pad is then grasped and gently separated from the aorta by blunt and sharp dissection from the psoas muscle and sympathetic chain posteriorly, and the peritoneum and ureter anterolateral.

■ Dissection progresses close to the ventral adventitial layer of the great vessels starting from the origin of the left common iliac artery up to the left renal vein.

■ Posterolateral the left sympathetic chain and main postganglionic fibers arising from the second or third lumbar sympathetic ganglia to join the superior hypogastric plexus are carefully isolated from the lymphatic tissue and preserved.

■ Cranially the left spermatic artery is controlled with bipolar coagulation at its origin and divided, then with bipolar coagulation the left renal vein is progressively dissected and the spermatic vein is clipped and divided close to the renal vein.

Avoid injury of a possible low renal artery or a lumbar vain during this dissection.

Early division of the right spermatic vessels is necessary to have the best exposure.

Avoid injury to the lumbar vessels or right renal artery while dissecting behind the left renal vein.

0 0

Post a comment