Retroperitoneoscopic renal surgery: Our approach

Introduction. In the United States and Europe, the retroperitoneoscopic app roach to renal surgery has generally been less popular than the transperito neal laparoscopic approach, primarily because of its "smaller" working spac e and surgeons' relative unfamiliarity with the optimal operative technique . Presented herein are our current techniques, developed in more than 400 r etroperitoneoscopic renal procedures at two major centers performing urolog ic laparoscopic surgery. Technical Considerations. Creation of an adequate working space in the retr operitoneum outside of, and posterior to, Gerota's fascia is a critical fir st step. At one institution, this working space is created with a balloon d ilator; at the other, finger dissection is employed for this purpose. A lon gitudinal incision is made in Gerota's fascia, parallel and close to the ps oas muscle, to access the renal hilum. During nephrectomy, the renal hilum is approached initially, followed subsequently by mobilization of the speci men. Conclusion. Retroperitoneoscopy allows superb, early access to the renal hi lum while avoiding the peritoneal cavity, and is our preferred approach for performing most laparoscopic renal surgery, including radical nephrectomy for cancer. The techniques we describe have made retroperitoneoscopy a depe ndable, user-friendly, and routine approach for minimally invasive surgery of the kidney at our two centers. (C) 1999, Elsevier Science Inc.