RETROPERITONEOSCOPY - A LAPAROSCOPIC APPROACH FOR ADRENAL AND RENAL SURGERY

Objectives, Retroperitoneoscopy has gained acceptance for urologic sur gery, We assessed the safety and efficacy of this procedure for renal and adrenal surgery. Methods. Since December 1994, 20 patients (18 to 75 years old) have undergone laparoscopic adrenalectomy and nephrectom y, including simple nephrectomy in 8, partial nephrectomy in 1, radica l nephrectomy in 2, tumorectomy with cyst excision in 1: and adrenalec tomy in 8. The retroperitoneal space was created by blunt dissection w ith the index finger, completed by insufflation, without balloon disse ction. Results. Average kidney size was 65 mm (range 50 to 108), and a verage adrenal tumor size was 31 mm (range 20 to 40). The average oper ating time was 127 minutes (range 60 to 180) for nephrectomy and 84 mi nutes (range 45 to 140) for adrenalectomy. The average hospital stay w as 3 days (range 1 to 7) for nephrectomy and 2.4 days (range 1 to 4) f or adrenalectomy, Average blood loss was 65 mt for both nephrectomy an d adrenalectomy. Conversion from the laparoscopic procedure to open su rgery was never required, Peritoneal effraction and ureteral injury oc curred in only 4 patients and 1 patient, respectively. Conclusions. Th e laparoscopic retroperitoneal approach is safe and effective for simp le renal nephrectomy and for excision of small adrenal tumors, Periope rative morbidity and hospital stay are reduced.