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Invited Critique
Feb 2012

Alternative Routes to the Summit Require Experienced Climbers: Comment on “Intertransversalis Fascia Approach in Urologic Laparoscopic Operations”

Arch Surg. 2012;147(2):167. doi:10.1001/archsurg.2011.1411

Just as there are often several approaches to ascend a mountain, each with its own pitfalls, the choice of an operative approach requires assessment of potential perils.

The retroperitoneal approach is more common in China than it is in the United States. It is difficult to make broad statements regarding the superiority of one approach as it is likely the surgeon's experience and comfort level, rather than technique, that determine success. As described by Li et al,1 the intertransversalis fascia approach provides a clean, clear, bloodless field. However, one of the chief concerns with the retroperitoneal approach, in general, is the smaller working space provided. The transperitoneal approach may provide a gentler learning curve for beginners.