Laparoscopic Anatomy of the Upper Urinary Tract: Intra-Abdominal and Retroperitoneal Approaches

Laparoscopy, with its advantages and limitations, requires a different topographic comprehension of surgical anatomy, adapted to a certain angle of vision and magnification. The anatomical perspective of the surgical field during laparoscopy is somewhat different from that usually seen during open surgery, and considering the anatomy from a different perspective is a prerequisite for performing safe and efficient surgery. Therefore, mastering laparoscopic topographic anatomy becomes indispensable for identifying structures and recognizing their spatial relationships. This chapter presents the topographic anatomy of the retroperitoneum as it appears to the laparoscopist. Positional relationships follow standard anatomical terminology, so that superior, inferior, anterior, and posterior refer to positions toward the head, feet, surface, and back, respectively. The right and left upper urinary tracts are presented separately.

For transperitoneal laparoscopy of the upper abdomen, the patient is placed on the operating table in a 45° lateral decubitus position, and the table is slightly flexed. For retroperitoneal laparoscopy, the patient is placed in a 90° standard flank position.