title: [6-year experience with extra peritoneal lumbar laparoscopic surgery: indications, complications, and results in a reference Southamerican center].
abstract: OBJECTIVE
  To report the experience in lumbar extraperitoneal laparoscopy surgery obtained while perfectioning the technique over a six-year period.
  
  
  METHODS
  We perform a prospective study with 168 cases of extra peritoneal laparoscopic surgery for the treatment of various kidney-ureter and adrenal diseases between 1999 and 2004. Operations were classified by organ and complexity (ablative or reconstructive). We describe the number of cases, surgical time, mayor and minor complications, number of open conversions, hospital stay, time to return to daily-life activities, advantages and disadvantages, as well as comparative analysis with data from bibliography.
  
  
  RESULTS
  Extraperitoneal access was employed in 168 laparoscopic operations: 44 renal biopsies, 8 renal cyst marsupializations, 49 nephrectomies (22 benign diseases/27 neoplasias). 15 nephroureterectomies. 22 adrenalectomies. 15 pyelolithotomies/ureterolithotomies, 1 neprhropexy, 2 partial nephrectomies. 11 pyeloplasties and 1 correction of retrocaval ureter. Operative time decreased significant only after the initial adaptation, with an average of 118 minutes in 138 ablative operations and 163 minutes in 30 reconstructive procedures. There was only one conversion in the second case of the series. The incidence of mayor and minor complications was 5.07% and 4.34% respectively for ablative surgery and 3.33% and 6.66% for reconstructive surgery. Average hospital stay varied from 1-4 days. Return to daily life activities took an average of 7 to 30 days in relation with procedure complexity.
  
  
  CONCLUSIONS
  Lumbar extra peritoneal laparoscopic access is an excellent option of minimally invasive approach to ablative surgery, offering the advantages of avoidance of the peritoneal cavity and low complication index. Reconstructive surgery is feasible but technically more challenging, depending of the ability and adaptation of the surgeon to a smaller surgical workspace.
authors.affiliation: Disciplina de Urología, Faculdad de Medicina de ABC, Santo André, São Paulo, Brasil. tobias-machado@uol.com.br
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
authors.forename: Marco
authors.initials: M
authors.lastname: Túlio Lasmar
authors.forename: Freddy
authors.initials: F
authors.lastname: Rincón Ríos
authors.forename: Pedro Hermínio
authors.initials: PH
authors.lastname: Forseto
authors.forename: Roberto
authors.initials: R
authors.lastname: Vaz Juliano
authors.forename: Eric
authors.initials: E
authors.lastname: Roger Wroclawski
mesh_terms: D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D001938:Brazil; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D014513:Ureter / Q000601:surgery*