Retroperitoneoscopic uretero-cutanostomy — our method of creating a pneumoretroperitoneum

Abstract

SummaryRetroperitoneoscopic procedures were already being performed in the late 1970s. The clinical breakthrough of retroperitoneoscopy, however, came in 1992 with the balloon-dissecting technique of Gaur, facilitated by the experience gained with transperitoneal laparoscopic procedures in the upper retroperitoneum. A 60 year old woman with infiltrative bladder cancer and right-sided obstructive uropathy was a high risk patient for an open surgical operation. Until now, our retroperitoneoscopic procedures were usually performed by hydraulic video-optically controlled balloon dissection. With this patient, for the first time we created a pneumoretroperitoneum using an optical trocar-Visiport. In this way we entered the retroperitoneum by visualising all layers of the abdominal wall. Once inside the retroperitoneum we created a work space by blunt and sharp dissection under optical control, avoiding blood vessels. The ureter, which was dilated by infiltrative bladder carcinoma, was easily identified, clipped and transected. The proximal end of the ureter was pulled out through the skin incision for the first trocar. The ureter was spatulated and stented, and ureterocutanostomy was performed in the same way as in open surgery.