Visualized Lateral Access

Direct Look™ is an MIS approach to lateral access, utilizing a series of streamlined retractors that enable direct visualization of the psoas muscle and identification of the corridor’s neural structures.

Weitlaners

Abdominis Muscles
 

Peritoneal Retractor

Peritoneum/Retroperitoneal Space

Psoas Muscle
 

MARS™3V

Disc Space
 


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Features

  • Incorporates Established Techniques to the Lateral Procedure

    Unlike traditional lateral procedures, Direct Look™ provides visualized access to the surgical corridor allowing the use of established surgical techniques through a muscle splitting approach rather than blind dilation.
  • May Help Reduce Iatrogenic Neural Complications

    Direct visualization eliminates the uncertainty of dilating blindly through the psoas muscle and allows for mobilization and avoidance of neural structures comprising the lumbar plexus, particularly the genitofemoral nerve.
  • Allows for Less Tissue Disruption Compared to Other Surgical Alternatives

    Direct Look™ is a lateral MIS technique that preserves key muscles of the back as well as the anterior and posterior longitudinal ligaments. It allows for a smaller incision and a muscle splitting approach that may help reduce blood loss and limit tissue damage.

Direct Look™ Enhances Traditional Lateral Surgery

  • • Direct visualized MIS Access

    • Reduces reliance on neuromonitoring, placing more control in surgeon’s hands

    • External and internal obliques, as well as the transversus abdominis muscles, are split in line with their fibers to help preserve cutaneous nerves

    • Sensory nerves, including the genitofemoral nerve, are directly identified as the psoas is dissected under direct visualization
  • • MIS approach

    • Heavy reliance on neuromonitoring

    • Additional posterior incision is made to protect the peritoneum as instruments pass through the lateral space to the spine

    • Blind dilation continues through psoas muscle, relying mostly on neuromonitoring for nerve identification
Aside from psoas retraction time, the majority of neural complications with traditional lateral surgery are believed to be caused by:
1. Blindly dilating through the psoas muscle, where the potential for injury to the lumbar plexus, particularly the genitofemoral nerve, is significant.

2. Inaccuracy and overreliance on neuromonitoring.

Direct Look™ is designed to overcome these complications with 4 steps after initial skin incision:

Split Abdominis Muscles

External and internal obliques along with the transversus abdominis muscles, are split in line with their fibers, to help identify and avoid cutaneous nerves, such as the ilioinguinal and iliohypogastric nerves.

Navigate Through Retroperitoneum to Expose Psoas Muscle

More accurate navigation of the retroperitoneal surgical corridor may help to avoid areas that neuromonitoring cannot detect, such as the kidneys, bowels, and organs of the peritoneum, potentially preventing major complications.

Transpsoas Access

Early identification of the genitofemoral nerve and more accurate navigation through the psoas muscle, may help avoid damage to the nerves comprising the lumbar plexus.

Sequential Psoas Dilation

Opening of the facial layer releases tension on the muscle and genitofemoral nerve, allowing a surgical corridor through the psoas for sequential dilation.

Comprehensive Line of Lateral Products