Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective.
OBJECTIVE
To assess technical preferences and current practice trends of retroperitoneal and pelvic extraperitoneal laparoscopy.


METHODS
A questionnaire survey of 36 selected urologic laparoscopic centers worldwide was performed.


RESULTS
Twenty-four centers (67%) responded. Overall, 3988 laparoscopic procedures were reported: transperitoneal approach (n = 2945) and retroperitoneal/extraperitoneal approach (n = 1043). Retroperitoneoscopic/extraperitoneoscopic procedures included adrenalectomy (n = 74), nephrectomy (n = 299), ureteral procedures (n = 166), pelvic lymph node dissection (n = 197), bladder neck suspension (n = 210), varix ligation (n = 91), and lumbar sympathectomy (n = 6). Mean number of total laparoscopic procedures performed in 1995 per center was 41 (range 5 to 86). Major complications occurred in 49 (4.7%) patients 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 injuries, n = 16; vascular injuries, n = 1 2). Retroperitoneoscopy/extraperitoneoscopy is gaining in acceptance worldwide: in 1993, the mean estimated ratio of transperitoneal laparoscopic cases versus retroperitoneoscopic/ extraperitoneoscopic cases per center was 74:26; however, in 1996 the ratio was 49:51.


CONCLUSIONS
Retroperitoneoscopy and pelvic extraperitoneoscopy are important adjuncts to the laparoscopic armamentarium in urologic surgery. The overall major complication rate associated with retroperitoneoscopy/extraperitoneoscopy was 4.7%.
Gill
I S
IS
Cleveland Clinic Foundation, Ohio 44195, USA.
Clayman
R V
RV
Albala
D M
DM
Aso
Y
Y
Chiu
A W
AW
Das
S
S
Donovan
J F
JF
Fuchs
G J
GJ
Gaur
D D
DD
Go
H
H
Gomella
L G
LG
Grune
M T
MT
Harewood
L M
LM
Janetschek
G
G
Knapp
P M
PM
McDougall
E M
EM
Nakada
S Y
SY
Preminger
G M
GM
Puppo
P
P
Rassweiler
J J
JJ
Royce
P L
PL
Thomas
R
R
Urban
D A
DA
Winfield
H N
HN
D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010818:Practice Patterns, Physicians'; D012187:Retroperitoneal Space; D011795:Surveys and Questionnaires; D014572:Urology / Q000379:methods*