Author Affiliation: Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia.
I read with interest the article by Li et al1 on the “intertransversalis” approach, based on the outdated concept of “bilaminar” transversalis fascia (TF).
Transversalis fascia is the single-layer investing fascia (epimysium) of the transversus muscle.2 Transversalis fascia has traditionally been conceived to be continuous with investing fascia of other muscles (ie, a continuous inner layer around the abdominal wall).2 This concept led to the acceptance of the presence of TF in places where transversus muscle is absent (eg, the posterior wall of the inguinal canal or behind the lower rectus sheath). In addition, the deeper to TF extraperitoneal layer, designated the “deep layer” of TF, is in fact a condensation (membranous layer) of extraperitoneal tissue,3 which is irrelevant to TF.
Mirilas P. “Intertransversalis” Approach for Laparoscopic Urology: Surgical Anatomy Concerns. Arch Surg. 2012;147(10):980-982. doi:10.1001/archsurg.2012.2210