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MIS lumbotomy in L2-L4

Thoracic and lumbar pathologies: Minimally invasive lumbotomy (L2-L4)

The first muscle layer is incised with cautery and retracted. The second layer is split and retracted.

The transversalis fascia is opened with caution to avoid injury to the peritoneum, which lies in the abdominal cavity.

A finger is used to split the muscle and detach it from the peritoneum to facilitate dissection. 

The retroperitoneal fat is a good landmark to detect the retroperitoneal space.