Surgical Anatomy of the 10th and 11th Intercostal, and Subcostal Nerves: Prevention of Damage During Lumbotomy

No AccessJournal of UrologyAdult Urology1 Aug 2011Surgical Anatomy of the 10th and 11th Intercostal, and Subcostal Nerves: Prevention of Damage During Lumbotomy Teunette van der Graaf, Paul C.M.S. Verhagen, Anton L.A. Kerver, and Gert-Jan Kleinrensink Teunette van der GraafTeunette van der Graaf , Paul C.M.S. VerhagenPaul C.M.S. Verhagen , Anton L.A. KerverAnton L.A. Kerver , and Gert-Jan KleinrensinkGert-Jan Kleinrensink View All Author Informationhttps://doi.org/10.1016/j.juro.2011.03.120AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In a descriptive, inventorial anatomical study we mapped the course of the 10th and 11th intercostal nerves, and the subcostal nerve in the abdominal wall to determine a safe zone for lumbotomy. Materials and Methods: We dissected 11 embalmed cadavers, of which 10 were analyzed. The 10th and 11th intercostal nerves, and the subcostal nerve were dissected from the intercostal space to the rectus sheath. Analysis was done using computer assisted surgical anatomy mapping. A safe zone and an incision line with a minimum of nerve crossings were determined. Results: The 10th and 11th intercostal nerves were invariably positioned subcostally. The subcostal nerve lay subcostally but caudal to the rib in 4 specimens. The main branches were located between the internal oblique and transverse abdominal muscles. The nerves branched and extensively varied in the abdominal wall. A straight line extended from the superior surface of the 11th and 12th ribs indicated a zone with lower nerve density. In 5 specimens the 10th and 11th intercostal nerves crossed this line from the superior surface of the 11th rib. In 5 specimens neither the 11th intercostal nerve nor the subcostal nerve crossed this extended line from the superior surface of the 12th rib up to 15 cm from the tip of the rib. Conclusions: Damage is inevitable to branches of the 10th or 11th intercostal nerve, or the subcostal nerve during lumbotomy. However, an incision extending from the superior surface of the 11th or 12th rib is less prone to damage these nerves. Closing the abdominal wall in 3 layers with the transverse abdominal muscle separately might prevent damage to neighboring nerves. References 1 : The retroperitoneal incision: An evaluation of postoperative flank 'bulge' . Arch Surg1994; 129: 753. Google Scholar 2 : Combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy. Surg Endosc1999; 13: 268. Google Scholar 3 : Surgical repair of the abdominal bulge: correction of a complication of the flank incision for retroperitoneal surgery. J Am Coll Surg2004; 199: 830. 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Google Scholar Departments of Urology and Anatomy and Neuroscience (ALAK, GJK), Erasmus University Medical Centre, Rotterdam, The Netherlands© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 186Issue 2August 2011Page: 579-583 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordskidneythoracic nervesurologic surgical proceduresiatrogenic diseaseabdominal wallMetrics Author Information Teunette van der Graaf More articles by this author Paul C.M.S. Verhagen More articles by this author Anton L.A. Kerver More articles by this author Gert-Jan Kleinrensink More articles by this author Expand All Advertisement PDF downloadLoading ...