The retroperitoneum along with its organs, glands, vasculature and nerves are taught. The retroperitoneal structures of the right and then left are presented sequentially emphasizing anatomic organization, differences between sides and circulation.

1. Understand the significance of the white line of Toldt.
2. Describe the course of the ureter.
3. Describe the auscultation site for the renal arteries.
4. Describe the macroscopic internal structure of the kidney.
5. Describe the position of the adrenal gland.
6. Be able to describe the distribution of the celiac, superior mesenteric and inferior mesenteric arteries.
7. Be able to describe the contribution of the splenic, superior mesenteric and inferior mesenteric veins to the portal system.
8. Explain the functional importance of the marginal artery of Drummond.

Right Retroperitoneum, Left Retroperitineum, Mesenteric Vessels

Remove the fatty tissue surrounding the kidney. This is the pararenal and perirenal fat.  The adrenal (suprarenal) gland is adjacent to the upper medial pole of the kidney. Spare this portion of fat surrounding the kidney.

Identify the renal artery, renal vein and ureter. You may need to divide the renal vein in order to see the renal artery and ureter.

You may be able to follow adrenal vessels to the gland at this point. Locate the adrenal gland.

Note the variability of renal arterial blood supply among donors. Note the short course of the renal vein to IVC. 

Bisect the kidney into anterior and posterior halves; use a large knife.

Identify the following structures:

• Renal cortex
• Renal columns
• Renal pyramids
• Major and minor calyces
• Renal pelvis
• Ureter

Identify the spleen, descending colon and sigmoid colon.  Mobilize the descending colon by incising along the white line of Toldt on the left side.

Expose the gonadal vessels on the left and locate the kidney.

Mobilize the 3rd part of the duodenum by incising along its inferior border. Reflect the duodenum to the right.

Locate and identify the following structures posterior to the anatomic position of the 3rd portion of duodenum:

• Aorta
• IVC
• Left renal artery and vein
• Adrenal gland
• Left gonadal vein
• Kidney
• Superior mesenteric artery and vein (SMA and SMV)
• Celiac artery
• Celiac plexus and splanchnic nerves (difficult to identify)

Elevate the greater omentum and locate the transverse mesocolon, i.e., the mesentery of the transverse colon. Move the small intestine laterally to identify its mesentery.

Follow the vasculature of these mesenteries. This will require blunt dissection. Some donors may have considerable fat in the mesentery that requires more extensive dissection. Note that sharp dissection is likely to damage this vasculature.

Incise the neck of the pancreas and reflect its body to the left to reveal the formation of the portal vein from the superior mesenteric vein and splenic vein.

Locate the origin of the superior mesenteric artery posterior to the portal vein.

Bluntly dissect segments of the mesentery at proximal jejunum and distal ileum. Examine the arcades (anastomoses) between branches of the vessels and the vasa recta.