title: The medial visceral rotation approach to the proximal abdominal aorta: how to assemble and use the omni-tract® retractor system.
abstract: Debakey, Creech and Morris were the first to report that unrestricted exposure of the distal thoracic and entire abdominal aorta could be achieved by a thoracoabdominal approach with rotation of the viscera from left to right in a plane anterior to the left kidney. Approximately ten years later, Shirkey and colleagues described the technique of transabdominal medial visceral rotation in a plane anterior to the left kidney to expose an injury to the proximal superior mesenteric artery. Shortly thereafter, Buscaglia, Blaisdell and Lim reported their experience in treating 46 patients with penetrating abdominal vascular injuries. They advocated the use of left to right medial rotation of the viscera to approach the aorta and its branches and the use of right to left medial rotation of the viscera to approach the inferior vena cava. They also described modifying the approach, by rotating the left kidney anteriorly and medially to access the posterolateral aorta. Subsequently, transabdominal medial visceral rotation became a popular approach for the treatment of traumatic injuries to the proximal abdominal aorta. The first published description of this approach in the elective sitting came from Crawford who used it to expose complex aneurysms involving the paravisceral and pararenal aorta.
authors.affiliation: Vascular Division, University of California at San Francisco, San Francisco, California.
authors.forename: T K
authors.initials: TK
authors.lastname: Ramos
authors.affiliation: Vascular Division, University of California at San Francisco, San Francisco, California.
authors.forename: R J
authors.initials: RJ
authors.lastname: Stoney