[Dorso-posterior extraperitoneal pelviscopy (DEP). From experiment to initial clinical application].
BACKGROUND
Dorsoposterior and/or perineal access to pelvic connective tissue spaces has lost its importance due to improved transabdominal techniques. Because of the development of minimally invasive surgery towards "soft-tissue endoscopy" we were interested in whether the video-assisted technique could give new impetus to the perineal approach. Successful experiments on corpses were followed by the first clinical application.


METHODS
After the dilation of the retrorectal, rectovaginal and rectoprostatical spaces with a dissecting balloon, pneumoextraperitoneum was established and all extraperitoneal structures of the pelvis could be dissected.


RESULTS
In the experimental and in the clinical situation the spaces could be perfectly surveyed. EXPERIMENTALLY: Complete, circular preparation of the rectum was achieved. Parts of the bladder, vagina and prostate were visualized ventrally. Laterally both ureters and the paraproctal and iliacal vessels could be dissected. In the clinical application the retrorectal space could be dilated without problems and it could be rinsed and drained. Postoperatively no complications were recorded. The patient could be discharged on the 17th postoperative day.


CONCLUSIONS
The described method is suitable for clinical use. Besides the described indication, further surgical applications exists.
Zerz
A
A
Chirurgische Abteilung, LKH-Bregenz.
Beck
J
J
Szinicz
G
G
D004239:Diverticulitis, Colonic / Q000175:diagnosis / Q000601:surgery; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery; D020706:Laparoscopes; D008297:Male; D052801:Male Urogenital Diseases; D008875:Middle Aged; D010502:Perineum; D012002:Rectal Diseases / Q000175:diagnosis / Q000601:surgery; D012187:Retroperitoneal Space; D020694:Sigmoidoscopes; D007507:Therapeutic Irrigation / Q000295:instrumentation; D014565:Urogenital Neoplasms / Q000175:diagnosis / Q000601:surgery*