EXTRAPERITONEAL LAPAROSCOPY - ANATOMICAL DISSECTIONS WITH EXPERIMENTAL BALLOON DILATORS

Objectives To develop balloon dilators in vitro and in cadavers and to evaluate the anatomy of the extraperitoneal spaces and their surround ings created by such balloons. Materials and methods Balloons of three different materials (condoms, fingers of surgical gloves, whole surgi cal gloves and 'party' balloons) were tested in an in vitro study and compared with a prototype balloon dilator used in cadavers. The balloo n dilators were used to create extraperitoneal spaces in the pelvic, t he loin and the iliac regions through stab incisions, The incisions we re extended after dilatation to examine the spaces created and the con sequent anatomical changes. Results In vitro, all balloons were found to have capacities of more than 10 L, except that made from the finger of a surgical glove. Early rupture after insertion and during dilatat ion was a problem in condom and party balloons. In cadavers. there was good exposure of anatomical structures within the extraperitoneal spa ces created. Reflections of peritoneum in the loin and the iliac regio ns were unmoved by balloon dilatation. Conclusions The prototype ballo on dilator possessed all the characteristics desired of an ideal instr ument for creating extraperitoneal spaces. Good exposure of anatomical structures by the balloon dilators allows a minimal dissection in ext raperitoneal laparoscopic procedures in the aforementioned regions. Th at the peritoneal reflection was unmoved despite adequate expansion of the balloons also means that the exact placement of secondary laparos copic ports is crucial in preventing peritoneal and colonic trauma.