Q. In a subcostal flank approach to the kidney, which of the following may be incised to increase upward mobility of the 12th rib?
The intercostal muscles between the 1th and 12th ribs
The latissimus dorsi muscle
The lumbodorsal fascia
The quadratus lumborum muscle
The costovertebral ligament
The costovertebral, or lumbodorsal, ligament is a strong fascial attachment between the inferior margin of the 12th rib and the transverse processes of the first and second lumbar vertebrae.
It is encountered only in posterior approaches to the kidney and can be incised to produce greater mobility of the 12th rib and provide greater exposure and access to the structures of the upper retroperitoneum.