FROM LAPAROSCOPIC TRAINING ON AN ANIMAL-MODEL TO RETROPERITONEOSCOPICOR CELIOSCOPIC ADRENAL AND RENAL SURGERY IN HUMAN

So far, laparoscopic approaches to kidney and adrenal have been limite d because of their retroperitoneal location. We here report eight rena l and adrenal endoscopic procedures performed in seven patients: two a drenalectomies for hyperaldosteronism, one adrenalectomy for isolated metastasis from an adenocarcinoma of the lung; two nephrectomies for e nd-stage infected hydronephrosis, two partial nephrectomies for small circumscribed lesions of the kidney, and one endoscopic resection for pain relief of a voluminous cyst at the kidney. The approach was trans peritoneal in two cases and retroperioneal in five cases using the ret ropneumoperitoneum insufflation technique. One patient was operated by a combined approach using the retro- and transperitoneal routes. All procedures were successfully completed endoscopically. The retroperito neoscopic approach of the kidney is safe and does not interfere with t he peritoneal organs. Its working space is tenuous, but allows a direc t access on the kidney with good exposure of its pedicle. For adrenal surgery, the retroperitoneoscopic dissection is more difficult, becaus e movements of instruments are often impaired by the closeness of the costal margin and the iliac crest. However, in case of difficulties we found it very convenient to switch from a retroperitoneal endoscopic approach to a combined coelioscopic and retroperitoneoscopic operation . Far from excluding each other, both approaches are complementary, pa rticularly for difficult situations (i.e., previous peritoneal or retr operitoneal surgery).