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.