RETROPERITONEAL LAPAROSCOPIC NEPHRECTOMY AND OTHER PROCEDURES IN THE UPPER RETROPERITONEUM USING A BALLOON DISSECTION TECHNIQUE

This article describes a hydraulic balloon dissection technique. The r etroperitoneum is developed via a small lumbodorsal incision between t he edges of the musculus latissimus dorsi and musculus obliquus extern us and then after visualization of its correct position the balloon ca theter is filled with 500-1,200 mi of warm normal saline (according to patient size). The device consists of the finger of a surgeon's glove ligated around the end of a rigid bladder catheter. The balloon insuf flation is maintained for 5 min to guarantee adequate hemostasis. Rece ntly, we have replaced the balloon catheter by a balloon trocar sheath allowing direct endoscopic control of the hydraulic dissection. After retrieval of the balloon the CO2 insufflator is connected to the firs t trocar. AU secondary trocars are placed under endoscopic control. Th e hydraulic dissection techniques also enable optimal creation of an e ffective pneumoperitoneum in children. Until now, we have used this te chnique for twelve procedures in the upper retroperitoneum including f ive nephrectomies, two nephroureterectomies, one tumor nephrectomy, on e nephropexy, one renal cyst marsupialization and two renal biopsies. Up to now we have encountered no major complications. Three of the nep hrectomized patients had undergone multiple previous abdominal surgica l interventions. The retroperitoneal approach allows the surgeon to ap ply similar dissecting techniques as used in respective open procedure s. It has become the routine approach for laparoscopic procedures in b enign renal disease. This procedure can be performed even in cases wit h previous abdominal surgery.