title: Simple techniques for atraumatic peritoneal dissection from the abdominal wall and for preventing peritoneal injury during trocar placement under retroperitoneoscopy.
abstract: OBJECTIVE
  Inadvertent peritoneal tearing causes pneumoperitoneum and makes retroperitoneal laparoscopic procedures technically more difficult. We describe some simple techniques of atraumatic peritoneal dissection and the prevention of peritoneal injury during trocar placement under retroperitoneoscopic guidance.
  
  
  METHODS
  After balloon dilation and the establishment of pneumoretroperitoneum a laparoscopic swab stick was used for peritoneal dissection from the abdominal wall under retroperitoneoscopic guidance. Exploratory puncture using a Cathelin (Terumo, Tokyo, Japan) needle was performed before trocar placement in close proximity to the lateral peritoneal reflection.
  
  
  RESULTS
  We applied this technique in our last 10 consecutive retroperitoneal laparoscopic procedures. No peritoneal rents occurred during dissection of the lateral peritoneal reflection or trocar insertion.
  
  
  CONCLUSIONS
  The laparoscopic swab stick technique described facilitates atraumatic peritoneal dissection as well as creation of an adequate working space. Exploratory puncture using a Cathelin needle is useful for preventing inadvertent peritoneal injury during trocar placement.
authors.affiliation: Department of Urology, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Wakabayashi
authors.forename: A
authors.initials: A
authors.lastname: Kataoka
authors.forename: K
authors.initials: K
authors.lastname: Johnin
authors.forename: T
authors.initials: T
authors.lastname: Yoshiki
authors.forename: Y
authors.initials: Y
authors.lastname: Okada
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D009392:Nephrectomy / Q000379:methods; D010537:Peritoneum / Q000293:injuries / Q000601:surgery*; D011677:Punctures / Q000379:methods; D012187:Retroperitoneal Space