RETROPERITONEAL AND PELVIC EXTRAPERITONEAL LAPAROSCOPY - AN INTERNATIONAL PERSPECTIVE

Objectives. To assess technical preferences and current practice trend s of retroperitoneal and pelvic extraperitoneal laparoscopy. Methods. A questionnaire survey of 36 selected urologic laparoscopic centers wo rldwide was performed. Results. Twenty-four centers (67%) responded. O verall, 3988 laparoscopic procedures were reported: transperitoneal ap proach (n = 2945) and retroperitoneal/extraperitoneal approach (n = 10 43). Retroperitoneoscopic/extraperitoneoscopic procedures included adr enalectomy (n = 74), nephrectomy (n = 299), ureteral procedures (n = 1 66), pelvic lymph node dissection (n = 197), bladder neck suspension ( n = 210), varix ligation (n = 91), and lumbar sympathectomy (n = 6). M ean number of total laparoscopic procedures performed in 1995 per cent er was 41 (range 5 to 86). Major complications occurred in 49 (4.7%) p atients and included visceral complications in 26 (2.5%) patients and vascular complications in 23 (2.2%). Open conversion was performed in 69 (6.6%) patients, electively in 41 and emergently in 28 (visceral in juries, n = 16; vascular injuries, n = 12). Retroperitoneoscopy/extrap eritoneoscopy is gaining in acceptance worldwide: in 1993, the mean es timated ratio of transperitoneal laparoscopic cases versus retroperito neoscopic/ extraperitoneoscopic cases per center was 74:26; however, i n 1996 the ratio was 49:51. Conclusions. Retroperitoneoscopy and pelvi c extraperitoneoscopy are important adjuncts to the laparoscopic armam entarium in urologic surgery. The overall major complication rate asso ciated with retroperitoneoscopy/extraperitoneoscopy was 4.7%. UROLOGY 52: 566-571, 1998. (C) 1998, Elsevier Science Inc. All rights reserved .