DIRECT CARBON-DIOXIDE INSUFFLATION OF THE RETROPERITONEUM UNDER LAPAROSCOPIC CONTROL FOR RENAL AND ADRENAL SURGERY

Objective: Assessment of the videoscopic approach to the retroperitone aI space in the vicinity of the kidney and the adrenal gland. Design: Open study. Setting: University hospital, Belgium. Subjects: 10 patien ts who underwent 11 operations (adrenalectomy, n = 3, nephrectomy, n = 5, partial nephrectomy, n = 2, and renal cystectomy, n = 1). Interven tions: Direct CO2 insufflation of the retroperitoneal space in order t o obtain a convenient retroperitoneal working space for renal and adre nal surgery. Outcome Measures: Feasibility, morbidity and mortality. R esults: 8 patients were operated on exclusively by the retroperitoneos copic approach; 2 required the retroperitoneal and transperitoneal rou tes to be combined to complete an adrenalectomy. No patients required brood transfusion and no patient died. Median postoperative stay was 3 days. Conclusion: The CO2 insufflation technique of the retroperitone um is safe and reproducible. Nevertheless, far from excluding each oth er, both approaches-laparoscopic and retroperitoneoscopic-are compleme ntary in difficult cases, particularly for adrenal endoscopic surgery and for larger renal lesions.