[Retroperitoneoscopy--experiences with the first cases].
A retroperitoneal access is most commonly applied for open procedures in urology. With introduction of the balloon dissecting technique, this anatomical route could also be used for laparoscopic surgery.


METHODS
From 12/1992 to 10/1997, a total of 200 retroperitoneoscopic procedures have been performed in 197 patients (age 4-82 years): 78 nephrectomies, 50 renal cyst resections, 14 nephropexies, 11 ureterolyses, 8 retroperitoneal lymph-node dissections, 8 renal biopsies, 6 adrenalectomies, 6 heminephrectomies, 6 pyeloplasties, 5 ureterolithotomies, 6 ureterocutaneostomies and 2 others. Thirty-eight patients (19%) had undergone previous abdominal surgery; 22 (11%) had had kidney and ureter operations. Dissection of the retroperitoneal space was done with a balloon catheter in 14 or a balloon trocar system in 93 cases, and in the last 93 patients digital dissection with the index finger proved to be sufficient.


RESULTS
We classified 76 as simple (i.e., renal biopsy, renal cyst resections, ureterocutaneostomy) and 102 as difficult (i.e. adrenalectomy, nephrectomy, nephropexy) and 22 (11%) as very difficult operations (i.e., pyeloplasty, heminephrectomy, lymphadenectomy). There has been a significant learning curve during the first 50 cases as reflected by increased operating time and complications and the conversion rate to open surgery. After that, the OR times mainly depended on the difficulty of the procedure, averaging 45-100 min for an easy retroperitoneoscopy, 95-185 min for a difficult and 185-240 min for a very difficult operation. In the last 50 cases, the complications, conversion and reintervention rate have become comparable to open surgery (2, 4 and 2%).


CONCLUSIONS
After more than 200 cases of retroperitoneoscopy, the access technique has been significantly simplified. The procedure is standardized, safe and reproducible.
Rassweiler
J J
JJ
Urologische Klinik, Städtisches Krankenhaus Heilbronn, Akademisches Lehrkrankenhaus, Universität Heidelberg.
Frede
T
T
Seemann
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012187:Retroperitoneal Space; D014570:Urologic Diseases / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*